Page 0018

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

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