Implementing national cancer control plans

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Published: 24 Jun 2019
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Dr Eduardo Cazap and Dr Lisa Stevens

Dr Eduardo Cazap speaks to Dr Lisa Stevens at the 2019 American Society of Clinical Oncology (ASCO) Annual Meeting for ecancer's Global Cancer Leaders initiative.

They discuss the position of global and international leaders in determining the future of global cancer control and ways to successfully implement national cancer control plans.

They highlight the resources available through the International Cancer Control Partnership, which can be found here.

EC: Today we are continuing the series, the special series of ecancer about the vision of global and international leaders, how they see the global picture of cancer control and future challenges and developments. Today we have with us a person that plays an important role in the international scene. Dr Lisa Stevens was, from the very beginning, with the Office of Global Health of the National Cancer Institute, US. Dr Stevens has not only the vision through her contacts with top leaders around the world, top leaders from international organisations, but also her local interpretation of the situations in different countries and regions of the world. Lisa, how are you?

LS: I’m doing well today, thank you Eduardo.

EC: I know that there are some things that are well known for us but on this occasion we need to transmit to bigger audiences the vision and the picture of cancer control from a global perspective. So, please, could you share with us which are your main points to comment to larger audiences about the role of the Global Health Office of the NCI, your role and your interpretation of the situation.

LS: Sure, thank you for the opportunity. I would say that with the adoption of the global action plan for NCDs and the call to all countries to have a national cancer control plan, the NCI and the international cancer control partners have been able to step in and assist countries, either in evaluating an existing plan or developing a plan where none existed. What I’d say is now after having done an evaluation of the plans that exist, we really want to see plans that have financial backing, plans that have an evaluation strategy and plans that are implemented because simply having a plan and checking the box and saying, ‘Yes, we’ve got a national cancer control plan,’ isn’t actually going to help patients. So we need to make sure that those plans are implemented, that the human resources are behind it and that the government has put financial resources to see that plan executed.

EC: I see from your answer that there are a couple of points. One is, or has been in 2011, the mandate of the United Nations to the country to implement real and concrete actions for NCDs.

LS: Yes.

EC: Okay. The other aspect is the planning aspect. So I have, regarding these two important points, two questions. One – how do you see the results after practically eight years of implementation of the plans and, second, how do you see the promotion of national cancer control planning in a more proactive way?

LS: We’ve definitely seen a growth since 2011 of countries that actually have a plan, so it’s up to about 87% of countries that have a plan. So now we need to look at are the countries implementing those plans because, as I said, it’s not simply enough to say that you have a plan or a strategy in cancer. So it’s looking at how do you integrate the cancer services into the existing health system. How do you make sure that individuals who are presenting at primary healthcare actually have a path to get a diagnosis and treatment if needed.

EC: The second question – how do you see that organisations or institutions or governments may better promote in a proactive way the issue of national cancer control planning operative and budgeted.

LS: At the National Cancer Institute what we’ve seen is it’s really a whole of society and there are parts of the WHO, especially some of the regional offices, which also promote this as a whole of society. So all the Ministry of Health and the NCD department or the cancer specialists may have a primary responsibility in developing and executing a plan. Plans that have input from civil society, from academic researchers, from other members of the community are actually more likely to be implemented and financed. So that it’s not one person’s responsibility, although if you have one person who is ultimately responsible that’s an indication that there will be results and actions. If you have a community who want to see the plan implemented and, again, want to have that impact on cancer patients, that’s really the way to approach the development implementation and financing of the plan.

EC: So, I understand that there are two points, very important, that you already mentioned. One is the concept of a leader or a champion at the country level, somebody that takes the flag. The other aspect is related with this important concept of a multi-stakeholder approach, a whole of society. This is something that we need to underline and to really make it very clear that this is a compromise for the planning in health and in cancer for the entire society.

LS: Right, so we developed with the WHO and with the Union for International Cancer Control a template in which to use to evaluate existing cancer control plans or NCD plans with cancer. This was done under the auspices of the International Cancer Control Partnership and one of the aspects we looked for in these plans was was there a champion or one person responsible and was a partnership identified within the cancer plan. Because, again, it’s not just one person’s responsibility, although you need that person to take leadership and ownership.

EC: So for the benefit of the audience, I’m not sure that many people know about the International Cancer Control Partnership, or ICCP. Could you please give some more detailed information and mainly I am the Minister of Health of a small country, I am a leader of a NGO, I need advice on how to implement, to better implement, a plan in my country.

LS: Back in 2012 when I first joined the Centre for Global Health we identified that there were many partners who were interested in national cancer control planning. So we thought it would be a good idea to bring together this coalition of the willing, these interested partners, to better understand what the different roles were. So there was no intention to take away anyone’s leadership in a particular area but really to look at how could we work together, how could we identify some areas of commonality and some areas where these partners were distinct. So some of the key partners from the beginning are, again, the Union for International Cancer Control, WHO and some of their regional offices, the International Atomic Energy Agency, the International Agency for Research on Cancer, American Cancer Society, Centres for Disease Control. So there were a lot of partners in the cancer control space. Again, we just wanted to have some level of coordination. Now we’ve evolved to have a portal that lists all publically available cancer plans, available NCD plans that have a cancer component, toolkits and the ability to request technical assistance. So, again, if a country has a plan and they want it to be evaluated, if a country is moving to a new phase or refreshing their plan, they can call upon the experts within this community for some advice and some guidance and some collaboration.

EC: So in the case that my minister requests some assistance I can suggest him to go to the

LS: It’s, yes.

EC: Fantastic. So now that you centralised your opinion about planning, do you have any second topic to be included in the global agenda that you consider an important priority part of planning?

LS: I think it starts with the plan. Again, what I’ve learned over the last seven years is that it’s not one single aspect of the plan but looking at how the different sectors fit into a system. So, as we’ve discussed, I will soon be moving to the International Atomic Energy Agency where radiotherapy and integration of radiotherapy into existing services is important. So it’s not the procurement of a machine or getting a machine in country, it’s making sure that that’s integrated so that patients that need that radiotherapy are shown how to access the treatment, so that you have appropriate training, so that you have appropriate maintenance schedules. So it’s really a plan but then how does that fit into the system, how does it fit into the primary healthcare system so that patients that present with signs and symptoms of cancer can access the appropriate diagnosis.

EC: So how can you explain to the audience about the need of data before the planning?

LS: Yes. Again, in the cancer continuum you have prevention, early diagnosis, treatment, palliation. However, you need to understand what the burden of cancer is so that the services that a country plans for, if it’s a specific screening programme, match the disease burden. So that’s where cancer registries come in and that’s why we always felt that the International Agency for Research on Cancer was a key partner in this cancer control planning because you need to understand what is your starting point, what is your baseline, what is your burden and, as you begin to implement different programmes, how is that impacting your burden. Is it actually showing a reduction as you implement prevention programmes or screening programmes. So data is key.

EC: So for the audience, for the promotion of better cancer control worldwide there are two elements that are fundamental – data, good data, and planning.

LS: Yes.

EC: I know that you are finishing your term at the NCI US and you have a new position as Head at the PACT programme in the International Atomic Energy Agency. First, congratulations.

LS: Thank you.

EC: Give us a panoramic vision of your next type of activities at the global scale.

LS: I’m very excited to be able to lead this programme and these committed staff members. There are two parts of the PACT programme, there’s the cancer control section which leads the imPACT missions that many people may be familiar with. That’s really, again, looking at the spectrum of health services and how does cancer and radiotherapy and diagnostic imaging fit into those existing services. The other part of the PACT programme is resource mobilisation – so how does a country develop documents that they can present to funders, whether that be some of the regional development banks or to their Ministry of Finance, in order to procure the funds to implement the recommendations from the imPACT missions. So I will be starting there this summer and I’m very excited to engage with both the people within the agency, both within the PACT programme and the other cancer experts, as well as the global cancer experts.

EC: So the conclusions of this conversation are that if you are planning to start some action in your country or in your province or in your city it is not necessary to reinvent the wheel. There are organisations, there are documents, there are recommendations, there are advisory groups that will help you in your programme or action. So it is one of the priorities for improvement of global cancer control worldwide. Lisa, thank you very much and all the best in your new position.

LS: Thank you Eduardo.