Swiss Cancer ResearchOur commitmentWe fund researchersOncology and Cancer Care ProgrammeMarcel Zwahlen – was is Health Services Research?Oncology and Cancer Care Programme

“I hope that the systematic and continuous learning process will continue.”

Coming to an end this year is the funding programme through which the Swiss Cancer Research foundation – in the framework of the National Strategy Against Cancer – has strengthened oncological health services research. In this interview, the president of the panel of experts that has evaluated grant applications to the programme provides a preliminary assessment.

Prof. Dr. Marcel Zwahlen, Präsident des Expertengremiums

Marcel Zwahlen, you are the president of the panel of experts for the programme for strengthening health services research in oncology and cancer care. What is health services research exactly?
That is a difficult question, a controversial issue that often leads to debate by the panel. The broadest denominator is perhaps that health services research is concerned with studying health services in real life. In the world of practice – under real life conditions – a lot of things are less clear than in theory. For instance, in many cases guidelines or policies set down what the ideal treatment looks like. But in everyday clinical practice, there are always deviations from that treatment. Health services research can describe how often – and why – clinical practice deviates from recommended treatments.

Why is health services research important? 
With our programme we do not fund research projects that are interested in a single molecule XY or that are strongly oriented towards the biomedical clinical picture. Instead, the focus is often on the patient experience: Cancer treatment is a complex matter; patients are usually seeing a number of different specialists, who often give too little thought to the fact that they are not the only actors in the treatment process – and who therefore do not always coordinate their work optimally. Research projects in health services research can reveal, for example, which interfaces function well and which not as well. 

What is special about health services research?
Health services research is distinguished especially by its interdisciplinarity. In Switzerland it is a relatively new branch of research that often also uses different methods than those traditionally used in the life sciences. In our programme, there are research projects working with qualitative interviews or focus 35 groups, a concept that originally comes from marketing. For this reason, the Swiss Cancer Research foundation, which funds the programme, brought together a panel of experts covering a wide range of disciplines – with specialists in medicine, the economy, statistics, nursing sciences, and other areas. What is also special about health services research is that the findings are usually context specific. In theory, a medication is equally effective anywhere in the world, but in practice, local conditions play an important role. Because the health system in Switzerland is set up differently than, say, in Great Britain, the results of a study there are not directly transferable to our conditions here. 

The research programme will soon come to an end. Are you satisfied with it?
We have not yet conducted a thorough review; that task still lies ahead. At the conclusion we will hold a meeting together with National Research Programme (NRP) 74. NRP 74 is the Swiss National Science Foundation’s programme “Smarter Health Care”, which focuses mainly on optimal care of patients with chronic conditions. Actually, the meeting was originally planned to be held in April. But due to the coronavirus, it has been rescheduled for the end of October. The goals of the meeting are, for one, scientific exchange: It will be an opportunity for the persons involved in the different “ 
For another, the aim is to draft scenarios showing what – after completion of the two research programmes – the future of health services research in Switzerland could look like.

What could it look like?
I hope that the systematic and continuous learning process that our research programme has initiated will continue. For that to happen, however, better organized data will be needed in the future. For instance, it is very difficult for researchers to obtain access to anonymized claims and billing data from health insurers. That set of data should be made more readily accessible – following clear regulations, naturally. After all, here in Switzerland we are all required to obtain health insurance. The data therefore do not belong to the companies but to society.