Qatar National Cancer Framework: Lessons learnt and key factors for success

The development of comprehensive cancer plans is a critical first step for countries to establish an effective cancer control programme. In 2017, the World Health Assembly (WHO) passed a resolution on cancer control which recommends that countries develop national cancer control plans (NCCPs) to guide all cancer prevention and management activities undertaken in a country.

UICC has been at the forefront of supporting the cancer control community in developping and implementing NCCPs, for example through the International Cancer Control Partnership (ICCP) Portal, a one-stop-shop for cancer prevention and control planning. In 2018, UICC, in collaboration with WHO and ICCP, conducted a global analysis of NCCPs, and national cancer control planning was the focus of two Public-Private Dialogues (PPDs) hosted by UICC during the 2019 ‘Leadership in Action’ meetings for the Middle East and North Africa (MENA) and Latin America regions.

In this interview, Dr Hadi Mohamad Abu Rasheed shares the learning from his involvement in the development of the Qatar National Cancer Framework 2017-2020 and outlines his recommendations for countries embarking on a cancer control planning exercise.

The National Cancer Framework 2017-2020 follows the first National Cancer Strategy 2011-2016 in Qatar. What are the lessons learnt from the earlier plan that helped inform the new strategy?

The National Cancer Strategy 2011–2016 helped set the environment for cancer care in Qatar to develop into a world-class level service and a benchmark for the Middle East region in developing a National Cancer Control Strategy.

One of the lessons learnt, is that no service or organisation can do it alone; the whole health system must be aligned around a clear vision and programme of work in order to achieve the desired results. Another is the importance of, robustly and objectively, monitoring and measuring the performance and quantifying the improvements delivered to justify the investment in cancer control to all stakeholders, including the higher leadership in the government.

Which other stakeholders in cancer control were involved in the development of the NCF2017-20 ?

The collaborative efforts in the development of the NCF2017-20 were led by the Ministry of Public Health (MOPH) and included all stakeholders in cancer control, such as Hamad Medical Corporation (HMC - the main provider of secondary and tertiary healthcare in Qatar), Primary Health Care Corporation (PHCC), Sidra Medicine (a state-of-the-art tertiary hospital), the academic health system, Qatar Cancer Society (QCS), and the private health sector. All contributed through their participation and involvement in the National Cancer Strategy Steering Committee responsible for the five-year review of the National Cancer Strategy 2011–2016.

The review was followed by a forum held for the health care professional community working in cancer and all above-mentioned stakeholders, as well as people living with cancer. This event marked the transition between acknowledging the successes of the past strategy and focusing on the future landscape of cancer care. The participants were asked to vote on key areas of focus along the patient pathway to inform the next six years and the results are represented throughout the current framework.

Which mechanisms are in place to monitor progress?

The framework mentions nine domains, based upon the six elements of the WHO cancer care continuum representing the complete patient pathway for cancer care, and three relevant enabling systems of performance management, workforce improvement and research for future innovation. The NCF recommended, for those domains, 61 guiding activities that can be completed in the process of achieving the 25 success measures and outcomes of the framework, which are aligned to eight global indicators of success, namely:

• Improved cancer education measured by the Cancer Awareness Measure
• Reduction in the numbers of smokers in Qatar measured by STEPwise
• Increased proportion of stage 1 and 2 diagnoses for breast and bowel cancer
• Increased proportion of patients entering the system via screening or urgent referral managed routes
• Publication and international comparison of 1- and 5-year cancer survival rates
• Increase in patients with complete care plans in place across the care pathway
• More patients staying in Qatar for cancer treatment
• More patients accessing ongoing care in primary care/community settings

Lead accountable organisations/stakeholders, baselines and targets have been established, along with appropriate tools to support the monitoring and reporting of performance against the measures for the Public Health Committee, National Cancer Committee and NCF annual report.

Who are the main actors responsible for implementing the plan, and which governance system is in place to account for progress?

The majority of activities will be implemented across the provider organisations, some with cross-provider responsibility. To ensure sound ongoing collaboration and joint reporting for these activities and measures, the Qatar Cancer Research Partnership, Cancer Patient Experience Group, National Clinical Advisory Groups, Cancer Communication Work Group and the Cancer Clinical Coordination Group report quarterly into the National Cancer Committee, which will present all providers’ performance monitoring on a quarterly basis as a combined quality and performance report to the MOPH. Each group will include multidisciplinary representation from MOPH, PHCC, HMC, private providers, Sidra, as well as QCS and patient representation.

How can patients inform services and activities through their experience?

The voice of patients who have experienced cancer care must be heard, understood and acted upon in the delivery of care. There are five main methods for gathering information on patient experience across the stages of the cancer care continuum: the cancer awareness measure tool, patient survey reporting, live reporting, retrospective feedback, and patient engagement groups.

Patient-reported outcome measures will be fed back into the performance management system. All major programs of work related to the NCF include a patient representative within the project team who will play an active role in shaping the future of cancer services along the Patient Pathway.

If you could share with a country embarking on a cancer control planning exercise your critical factors for success, what would they be?

Key success factors in my experience are:

• Building true partnership networks between all stakeholders, assigning clear roles, responsibilities and accountability for each organization
• Advocacy to the highest level of leadership in government regarding the relation between the cancer burden and the sustainable development of the country, and the impact of investment in cancer control on the growth of the country
• Developing a sustainable investment plan for the national cancer control programme
• Patient engagement in all aspects of the national cancer control programme
• Ensuring the national cancer control program outcomes are patient-centred outcomes
• Key performance indicators driving processes and programs
• Efficient governance
• Reliable performance monitoring and evaluation to ensure programmes are appropriately prioritized according to the country needs and to assure quality
• Accurate data, including reliable cancer registries
• Investing in enabling systems such as workforce improvement and research for future innovation in processes, systems, programs and technologies

What would your recommendations be for a cancer society or organisation wishing to support cancer planning in their country?

Advocacy is the key. A cancer society should provide a platform for all stakeholders involved in cancer control to come together to advocate for the establishment of a national cancer control programme. Advocacy should aim at the high leadership in government and make the link between investing in cancer control and the development and growth of the country. Finally, involving patients is crucial, as they make for powerful advocates for a national cancer control programme.