centres. In accordance with WHO's framework for health
system development and its building blocks (11), planning
care delivery for cancer management requires scaling up the
availability of trained health-care providers, access to
medicines and technologies for cancer treatment, the
development of national treatment standards and the
establishment of a governance structure for cancer care
delivery systems and their monitoring and financing. Figure
1 provides examples of the distribution of essential cancer
diagnosis and treatment technologies that are needed at all
three levels of care.
Planning a NCCP
The 12th General Programme of Work and Programme
Budget (12) is setting WHO's priorities in health planning.
Cancer control is included as part of the NCD-related
strategies and actions. Among the four major NCDs (cancer,
CVD, diabetes, COPD), it was cancer control which was
thought-out first with the overarching principle of
integrating prevention and control into one national plan.
This principle of comprehensiveness has been extrapolated
to the other major NCD conditions which are part of the
global NCD Action Plan (4). A national cancer control
planning process starts (defined as step 1 (14)) with an indepth
situation analysis of the cancer burden and underlying
risks and the availability of services for early detection,
CANCER CONTROL PLANNING
16 CANCER CONTROL 2015
Source: Global Analysis of CCS, CCO/WHO, 2012
Primary care level
Early referral of suspicious cases, simple surgical procedures (e.g. cryotherapy of pre-cancerous lesions of the cervix),
retrieval of patients who abandon treatment, patient support groups, patient education and rehabilitation,
education and training of community caregivers including traditional healers
Tertiary care level
(national or regional hospital)
Diagnosis
Imaging: X-ray, ultrasonography, mammography, computerized tomography (CT) scan, endoscopy
Laboratory: cytology, haematology, histopathology, prognostic markers, immunochemistry
Treatment
Radiotherapy, complex surgery and chemotherapy, rehabilitation, psychosocial support,
self-help groups, patient education programmes
Secondary care level
(district hospital)
Diagnosis
Imaging: X-ray, ultrasonography, mammography, endoscopy
Laboratory: cytology including fine-needle aspiration, haematology, biopsy, routine histopathology
Treatment
Moderately complex surgery and chemotherapy (mainly outpatient clinics), rehabilitation, psychosocial support,
self-help groups, patient education programmes
Figure 1: Distribution of cancer diagnostic and treatment services across the levels of care in a typical middle-income country
diagnosis, treatment and palliative care. Population-based
cancer registries are the source of solid data about the
incidence and pattern of cancer from which evidence-based
decisions can be taken on priorities to address cancer
prevention, early detection/screening and management.
Step 2 requires an open discussion among stakeholders so
that they have ownership of the decisions taken for the
cancer plan. Government, civil society professional
organizations and leading experts and patient groups are
needed for their input and commitment. This planning phase
ends up with the formulation and political endorsement of a
NCCP document which includes all four pillars of the
comprehensive cancer control framework. Implementing
the plan depends on the availability of resources, political
will and a governance and reporting mechanism.
Implementation needs to be accompanied by a monitoring
system so that deficiencies in progress can be identified and
managed.
Some countries are working on their national cancer
planning processes with the International Atomic Energy
Agency (IAEA) and its PACT programme. Entry point for the
IAEA to become involved are requests for technical support
on developing national capacity in radiotherapy services. In
responding to this request, IAEA makes the existence of a
NCCP mandatory for any support and follow up. IAEA PACT
has developed a global cancer assistance programme which