Cancer is a challenging disease for all health systems, and the lack of a national cancer strategy can make it more difficult for them to be accountable and aware of best practices.
In an article published in Foresight Global Health, Zuzanna Tittenbrun, Global Resources Manager at UICC and Sonali Johnson, Head of Knowledge, Advocacy and Policy at UICC and former member of the ICCP Steering Committee, develop how the ICCP global health partnership is helping countries to fill this gap.
National cancer control plans (NCCPs) are strategic public health documents that serve as a roadmap for countries to design and implement efficient prevention and control that take into account the context of a country’s cancer burden, risk factors, prevalence, available resources, sociocultural environment and healthcare system.
80% of all countries worldwide have a National Cancer Control Plan in place, compared to 66% back in 2013. Many countries, however, are lagging with plan implementation due to a lack of political will and insufficient resources. The 2018 global review of NCCPs underlined this issue, showing that while 55% of countries listed the need to budget NCCPs, only 10% of these provided details about how the plan would be resourced.
Furthermore, only a few plans address the particular challenges that vulnerable populations encounter in accessing cancer services due to stigma, discrimination or assumptions, or due to geographical location, financial hardship or other barriers known as the social determinants of health. Such populations include racial and ethnic minorities, indigenous peoples, the LGBTQI+ community, older adults, people living in remote areas and those from low socio-economic backgrounds.
Indeed, a review of national cancer control plans globally reveals that only 51 countries (out of 153) mention vulnerable populations. Even inthe few plans where they are mentioned do not refer to all the relevant populations.
Inequities can arise in different areas of cancer prevention and control; for instance, a lack of reliable information on the harmful effects of tobacco harmful effects or on cervical cancer and the benefits of HPV vaccination.
Cancer care for older adults is another example, with the age threshold for clinical trials often excluding the patients who represent more than half of all people living with cancer globally. Ethnic minorities also would benefit from higher representation in clinical trials as demonstrated by research conducted by Accountability for Cancer Care through Undoing Racism and Equity (ACCURE).
Data is essential to designing comprehensive national cancer control plans. In the last two years, the COVID-19 pandemic highly impacted global health systems and disrupted cancer services across the board (prevention, treatment and supportive care) – but countries with poor health and data surveillance systems have struggled much harder.
“A NCCP must be comprehensive enough to have an impact at the policy level. It’s an evolving document that steers the national cancer strategy and should not stay on the shelf but be put in action for the entire population in an equitable manner, mirroring the diversity of the society.”
– Yannick Romero, Ph.D, Knowledge & Advocacy Manager, UICC and Member of the steering committee of the ICCP
The development and implementation of an effective, comprehensive NCCP requires inclusive multi-sectoral and multi-disciplinary approaches that includes all of a country’s diverse populations, including the underserved and least privileged. It will be the only way to close the gap in cancer care.
– Unites more than 20 international organisations
– Hosts a library of national cancer control plans (NCCPs)
– Provides technical assistance and resources for NCCP development and implementation
– Facilitates cancer planning networking
The International Cancer Control Partnership (ICCP) is a group of organisations co-founded by UICC and engaged in cancer control planning efforts. The aim is to assist countries in development, implementation and monitoring of their national cancer control plans. In particular, the Partnership launched in October 2020 an ICCP ECHO Program focusing on NCCP implementation.
This tele-mentoring programme convened a first cohort of eight country teams (Cameroon, Eswatini, India, Kenya, Malawi, Nigeria, Rwanda and Tanzania) to identify priorities for the implementation of their specific cancer control plan. The monthly sessions covered a broad range of topics, such as how to use data for NCCP implementation as well as for monitoring, evaluation, and research, and “Increasing Awareness of Cancer Prevention and Early Detection In the COVID-19 Era to Mobilizing the Cancer-Related Healthcare Workforce”.
Following this initial success, Eswatini, Nigeria and Tanzania remained in programme, and three new countries (Bhutan, Sri Lanka and Uganda) have now been enrolled.
“Although Sri Lankan government has prioritised cancer as a major health issue, the National Cancer Control programme of Sri Lanka directed a new path after the imPACT review recommendation in 2019, conducted by the International Atomic Energy Agency. Many new key accomplishments in the cancer spectrum have been implemented to fill the gap for equitable services after the imPACT review. This was further supported by assessing the Sri Lankan Cancer Control plan by the International Cancer Control Partnership. Capacity building for NCCP by the ICCP ECHO will further complement the national programme and strengthen equitable services.”
– Dr. Janaki Vidanapathirana, Acting Director of Policy Analysis & Development , Ministry of Health, Sri Lanka