Now more than ever, it is important for countries to direct
resources more efficiently to cancer control efforts by
developing comprehensive national cancer control plans
(NCCPs). NCCPs provide all countries with a blueprint to
deliver cost-effective cancer control programmes that can
reduce cancer incidence and mortality, improve the quality
of life of cancer patients and their communities and reduce
the impact of cancer on national economies.
What makes a good NCCP?
The World Health Organization (WHO) defines NCCPs as
"public health programmes designed to reduce cancer
incidence and mortality and improve the quality of life of
cancer patients, through the systematic and equitable
implementation of evidence-based strategies for
prevention, early detection, diagnosis, treatment and
palliation, making the best use of available resources" (10).
A number of elements are central to developing a
comprehensive NCCP that meets the current and future
health needs of a country's cancer burden. In particular,
many countries struggle to produce NCCPs that consider
the whole continuum of care: prevention, early detection,
diagnosis, treatment, rehabilitation, palliation and research
(11). Moreover, many NCCPs fail to adopt a health systems
approach that sets out governance arrangements, resource
allocation and financing around measurable goals to support
a country's cancer control efforts.
An NCCP should provide a sustainable strategic plan for
cancer control, based on the country's cancer burden,
cancer risk factor prevalence and the resources available to
implement the plan. It should also take into account the
socioeconomic environment and healthcare system in that
country (12). The most effective NCCPs are developed with
the involvement of multisector stakeholders to set realistic
objectives that respond to the population's cancer needs
(13).
The availability of reliable cancer surveillance data,
including cancer incidence, stage at diagnosis and mortality,
generated by population-based cancer registries is vital for
developing targeted and effective NCCPs and for evaluating
the impact of national programmes. Yet, good-quality data
are often unavailable; in Africa, Asia, and Latin America,
coverage of high-quality data from registries is well below
10%. There is an urgent need to build this capacity in these
regions (14).
Importantly, the cost of establishing a robust cancer
registry in most countries is comparatively low when
considered against the cost of the cancer burden in that
country. In the United States alone, the annual burden of
cancer is more than US$ 216 billion, whilst less than US$ 75
million (0.03%) is spent annually to fund the Centers for
Disease Control and Prevention's (CDC) National Program
of Cancer Registries (NPCR) (15).
The current status of NCCPs: The global picture
Despite compelling evidence that NCCPs effectively
improve cancer services and outcomes, many countries,
particularly LMICs, have yet to develop or implement
NCCPs. A major source of concern is that many countries
implement NCCPs with significant gaps. A recent WHO
Assessment Report highlights that as many as 81% of
countries have cancer plans, policies or strategies in place,
but when looking at those that have an operational plan, this
percentage dropped to 59% and dropped again to 48% for
operational plans with dedicated funding (see Table 1 and
Fig. 1) (16). The Assessment Report defines "an operational ...
plan as one that is currently being implemented in the
country" while "a non-operational plan is one that exists on
paper but is not being implemented" (17). The African Region
has the lowest percentage of countries with cancer policies,
plans or strategies, while the Region of the Americas,
European Region and Western Pacific Region report the
highest percentage (see Fig. 2) (18). The Eastern
Mediterranean Region and South-East Asia Region also
report a high percentage of countries with cancer policies,
plans or strategies (see Fig. 2) (19).
Despite a high percentage of LMICs reporting plans,
policies or strategies for leading NCDs, this highlights the
widening gap between HICs and LMICs in capacity to
develop, implement and fund NCD-related plans, policies or
strategies (20). Although 83% of LMICs have an NCD policy,
only 59% of them are operational and 51% are operational
with dedicated funding compared to HICs where 96% have a
policy and 87% have an operational policy with funding (see
Fig. 3) (21).
The evolving NCD agenda: An opportunity for
accountability and action
As the incidence of cancer and other NCDs escalates to
epidemic levels, there is a clear need to promote a sense of
urgency among countries to develop and implement national
cancer plans and to reassess existing plans. In doing so, the
challenge incumbent upon the cancer community is to
promote evidence-based policy-making while also
advocating for an increase in resources to fund national
cancer plan implementation and sustainable scale up.
The UN Political Declaration on NCDs adopted in
September 2011 laid out actions addressed to all
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