NATIONAL CANCER CONTROL PLANS
Translating commitments into action
National cancer control plans or programmes (NCCPs) are crucial to achieve the World Health Assembly-agreed reductions in cancer-related mortality. However, their implementation is still hard to achieve.
The World Health Organization (WHO) defines a National Cancer Control Plan as ‘a public health programme designed to reduce cancer incidence and mortality and improve quality of life of cancer patients, through the systematic and equitable implementation of evidence-based strategies for prevention, early detection, diagnosis, treatment, and palliation, making the best use of available resources’.
There is growing evidence that the concrete way to translate the latest achievements of research and the commitment to cancer into practice comes through the implementation of NCCPs.
In 2013, the World Health Assembly and ministers of health globally agreed plans for the prevention and control of non-communicable diseases (NCDs) and accepted a target of a 25% relative reduction in the overall mortality from NCDs by 2025. “Having global recommendations represents a first step in the achievement of a better cancer care,” highlighted Giuseppe Curigliano from Istituto Europeo di Oncologia (IEO), Milan, Italy. “The second step is to put them into practice at a national level. The development and implementation of NCCPs, which are comprehensive and evidence-based resource plans, allow countries to translate commitments for cancer into action.” There are both political and practical reasons why the development of a country-specific NCCP is crucial to optimising the management of cancer. If a country does not have a structured plan, which takes into account variables including available services and cancer burden, it is unlikely to achieve its goals.
According to a recent review (Lancet Oncol. 2018;19:e546–555), 82% of the WHO Member States have publicly available cancer-related plans, with discrepancies in their development and domains that are part of the plan. “This really depends on a country’s priority,” said Curigliano. “For some, this will be prevention, for others treatment. Information from cancer registries can provide the picture of a country’s disease burden and form the basis of prioritisation of action.”
There is no one-size-fits-all model for optimal NCCP implementation. The International Cancer Control Partnership (ICCP) – a group of international organisations engaged in cancer control planning efforts – is involved in supporting the development, implementation and evaluation of NCCPs. In addition, for the last two decades, the International Cancer Screening Network – a consortium of countries, organisations, and experts acting as a critical resource for countries that have active population-based cancer screening programs in place – has worked with the National Cancer Institute (NCI) to promote evidence-based cancer screening implementation. Detailed budget planning and resource allocation are still major challenges according to Lisa Stevens, formerly from NCI US Center for Global Health. “A programme cannot be set up in isolation. For example, if you organise a screening programme, you must make sure that you have the resources to fund not only this but also the treatment that will be required when cancers are detected.”
Economically realistic NCCPs not only focus on the most important priorities but also use available tools to help estimate the costs of proposed strategies. “One such tool, developed for cervical cancer, uses an algorithm to estimate costs based on healthcare workers numbers and materials used", explained Stevens. "The WHO is currently working on a costing tool for around 20 different cancers in different income situations and is conducting pilot testing.” Another way to optimise constrained resources is to target the population most at risk. “For example, the US Preventive Services Task Force has raised the age for mammography in the US to at least 50 years, which avoids over-screening and an unnecessary burden on the healthcare system”, continued Stevens. “However, long-term impact will only come with sustained government investment and, as the person who makes the decision to invest is unlikely to be the person in power when the successes start to happen, this is sometimes a hard sell.”
The European experience: Spain
José Martín Moreno, University of Valencia, Spain
The Latin American experience: Brazil
Felipe Roitberg, Institute of Cancer of State of Sao Paulo (ICESP), Hospital Sírio Libanês, Brazil
The Asian experience: India
Supriya Chopra, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India