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Journal of Cancer Policy
journal homepage: www.elsevier.com/locate/jcpo
Short Reports and Communications
Supporting evidence-based national cancer control Asia-Pacific Phase II Leadership Forum
Tulika Singh1, Paul C. Pearlman, Brenda Kostelecky *
Center for Global Health, National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services, 9609 Medical Center Drive, Room 3W260, Rockville, MD 20850, USA
ABSTRACT
The steady increase in cancer incidence and mortality in the Asia-Pacific presents a growing challenge to countries in the region. National cancer control planning provides key strategies for countries to decrease their cancer burden and address risk factors in the context of their populations and health systems. Evidence-guided approaches allow countries to target resources towards highly-needed and effective cancer programs, while partnerships can serve to diversify sources of support, increase coverage and sustain services. Many countries struggle to develop and implement national cancer control plans (NCCPs) due to barriers in coordinating diverse stakeholders, limited funding and absence of evidence to guide program and health infrastructure improvements. The Cancer Control Leadership Forum (CCLF) program aims to address critical hurdles in cancer control planning by: (1) convening cancer control leaders from diverse sectors; (2) raising awareness and capacity of participating country representatives to develop and implement NCCPs; (3) facilitating development of country action-plans; and (4) providing technical assistance. Two years after participating in their first CCLF, eight countries from Southeast Asia and the Pacific, represented by multiple cancer control leaders from each country, participated in an Asia-Pacific Leadership Forum Phase II (APLF2) in 2016. The APLF2 facilitated valuable experience-exchange amongst regional and international experts, and explored areas of common interest, including: improving cancer registries, strengthening training, coordinating stakeholders, maximizing resources and overcoming implementation challenges. These priorities guide on-going cancer control efforts and serve to inform the international community of trends, needs and challenges in cancer control in Southeast Asia and the Pacific.
Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://
creativecommons.org/licenses/by-nc-nd/4.0/).
planning: The
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ARTICLE INFO
Article history: Received 21 December 2016 Accepted 8 March 2017 Available online 9 March 2017
Keywords:
Health care quality, access, and evaluation Public health Health planning Policy
Socioeconomic factors
Oceania
1. Introduction
Cancer incidence and mortality are rising in the Southeast Asia and Pacific (Oceania) regions. GLOBOCAN models predict an increase in cancer cases in the combined region from 942,000 in 2012-1.55 million in 2030 (a 60% increase) and cancer deaths from 588,000 to 1.02 million (a 58% increase) over the same period [1]. Strategic planning for cancer control can help countries develop policies and programs in a way that encourages evidence-based decision-making, efficient use of resources, quality of care and equitable access. Successful implementation of a strategic National
* Corresponding author. E-mail addresses: tulika.singh@duke.edu (T. Singh), paul.pearlman@nih.gov (P.C. Pearlman), kosteleckybd@mail.nih.gov (B. Kostelecky).
1 Present address: Department of Molecular Genetics and Microbiology, Duke University Medical Center, Box 3054, 213 Research Drive, Durham, North Carolina 27710, USA.
Cancer Control Plan (NCCP) requires strong foundational elements including diverse and engaged partnerships, dedicated financial support and leadership from both the government and community [2].
The Cancer Control Leadership Forum (CCLF) program was developed to support countries in their cancer control planning and implementation efforts through an evidence-guided, multi-sectoral approach [3]. The regional CCLFs convene 4-7 country teams, each with 3-8 cancer control leaders representing government, civil society organizations (CSO), academia and healthcare delivery sectors. Phase I Forums were designed to increase awareness of the importance of national cancer control planning and implementation, enhance understanding of how to develop and implement a NCCP, initiate forward momentum through country development of 12-month action plans and provide technical assistance. In 2014, the U.S. National Cancer Institute (NCI) conducted Phase I CCLFs in Southeast Asia and the Pacific, with ten total countries participating (Fig. 1). Eight of the countries participated in the
http://dx.doi.org/10.1016/jjcpo.2017.03.002
2213-5383/Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Fig. 1. The Asia-Pacific Phase II Leadership Forum reconvened eight countries from two previous CCLFs. The Southeast Asia Forum (shown in red) was held in Kuala Lumpur, Malaysia in April 2014 and was supported by the U.S. National Cancer Institute. The Pacific Forum (shown in blue) was held in Melbourne, Australia in December 2014 and was supported by the U.S. National Cancer Institute, Peter MacCallum Cancer Centre, Union for International Cancer Control, Cancer Council Victoria, and McCabe Centre for Law and Cancer. Two countries (listed in grey) participated in the Pacific Forum, but were not engaged in the Asia-Pacific Leadership Forum Phase II.
12-month follow-up period and reported progress on their action plans that ranged from developing NCCPs and formalizing national cancer partnerships to increasing funding for and improving cancer registries and data collection systems. At the end of the follow-up period, the eight countries expressed a desire to remain engaged in the CCLF program to address remaining challenges.
In March 2016, the eight countries that remained engaged for the entirety of the Phase I the Southeast Asia and Pacific CCLFs were reconvened for a Phase II Forum. The Asia-Pacific Leadership Forum Phase II (APLF2) was designed to continue building on countries' successes in cancer control planning, with two specific goals: (1) to further support multi-sectoral partnerships and ensure inclusion ofadvocates, academics and healthcare providers in planning and policy-making; and (2) to strengthen countries' ability to collect and use data to inform strategic decisions on health policies and determine impact of programs implemented through the national cancer plan. This report describes the APLF2 methodology, initial outcomes, challenges, lessons learned and future directions for supporting strategic planning for cancer management in low-and middle-income countries.
2. Methods
The APLF2 consisted of a three-stage process. The first stage involved reengaging country teams, revisiting their Phase I action plans, and soliciting input on their current cancer control planning needs and challenges. Based on identified needs, the primary organizers assembled a planning committee of international partners. The committee gathered and generated evidence-based tools, resources and examples to share at the Forum. Organizers worked with a leader from each country to assemble a multi-sectoral team empowered to enact cancer control change in their country.
Second, a one-day, in-person Forum was held in Singapore that included two types ofsessions: panel-plus-roundtable sessions and country action-planning sessions. The panel-plus-roundtable sessions began with international cancer experts giving remarks on
their respective topic areas, followed by roundtable discussions on the same topics (Table 1). This format allowed dedicated time for participants to discuss specific issues in small groups with the panelists. The action-planning sessions aimed to develop country-specific 12-month plans that identified priority items to move cancer control planning and implementation forward. The content of the plans was decided upon by the country team members, while facilitators aided in consensus-building and maintaining focus on identifying and articulating specific strategies and timelines.
Lastly, after returning home, country teams finalized their 12-month action plans, began to implement the action plans and communicated with faculty around further technical assistance
Table 1
Topic areas from the panel-plus-roundtable sessions during the Asia-Pacific Leadership Forum Phase II. Each panel member provided brief remarks about theirtopic, followed by a whole group question and answer session. Directly afterwards, participants met with speakers in small group roundtables to discuss each topic area in greater detail.
Panel/Roundtable 1 Topics: Advancing national cancer control plans and
partnerships
• Plan development and implementation
• The role of partnerships in resource mobilization for cancer control plan implementation
• Plan and cancer control costing
• Policies to improve national cancer control programs
• Strengthening stakeholder involvement
Panel/Roundtable 2 Topics: Strengthening specific cancer control and research efforts through national cancer plan implementation
• Cancer registry
• Prevention
• Screening and early detection
• Linking early detection, diagnosis and treatment
• Palliation and survivor care
• Implementation and evaluation of national cancer control plans
needs. In addition, several of the countries presented their progress, challenges and lessons learned related to their participation in the CCLF program at the 2016 Asia-Pacific Leaders' Summit in Brisbane, Australia.
3. Results
Fiji, Indonesia, Malaysia, Myanmar, Papua New Guinea, the Philippines, Thailand, and Vietnam participated in the APLF2 (Fig. 1) as country teams. A total of 77 attendees participated, with 50 team members from multiple sectors in the eight countries. The 27 additional attendees included country team facilitators, panelists, roundtable moderators and partners from international organizations. Inclusion of many partners to assist with design and implementation of the program enabled organizers to expand the available subject-matter expertise, facilitate small-group discussion during the Forum workshop and improve follow-up technical assistance capacity.
One key outcome of the APLF2 was effective exchange of successes, challenges and lessons to help countries develop strategies for improved cancer prevention and control. Another major outcome was each country's development of a 12-month action plan with priority action areas and specific tasks for each area based on the countries' respective needs, strengths and opportunities (Table 2). Common priorities across the countries include: strengthening cancer control partnerships; coordinating cancer control services and programs across the country; enhancing cancer registries; improving palliative care; training healthcare providers in evidence-based practices; and continuing to develop, implement and evaluate NCCPs.
4. Discussion
A key strength of the APLF2 has been to foster experience-exchange amongst countries on both common and unique experiences. Leaders shared what is working well and - equally important - what has not worked in cancer control planning and implementation. The dedicated opportunity to share experiences was welcomed by participants and partners as an effective way to learn how other countries are managing cancer prevention and control activities, advance evidence-based policymaking and integrate cancer control efforts within the broader health sector. This dialogue also helped inform international experts, researchers and other partners on current needs, trends and gaps in cancer control in Southeast Asia and the Pacific.
One common challenge raised was the need for stronger healthcare systems to drive improvements in cancer prevention and control. Several countries suggested addressing this challenge by integrating planning across different government departments and ministries to build on existing infrastructure and workforce, including those within health (e.g. NCD, HIV/AIDS, women's health) and outside health (e.g. education, labor, finance). Others highlighted their efforts to strategically strengthen components across the health system that build on one another. Indonesia, for example, reported their aim to complement public cancer awareness campaigns with expanded services to meet the anticipated increase in demand.
A common need across the countries was human resource development. Both Fiji and Myanmar underscored the importance of strengthening relationships with international partners and regional institutions, which serve as twinning partners and can provide training in cancer registry management, clinical care programs, cancer research and oncology nursing. Enhanced regional training opportunities were enthusiastically supported by
Table 2
Summary of country priority action areas as outlined by each of the country teams during the action-planning sessions at the Asia-Pacific Leadership Forum Phase II. Each 12-month action plan outlines tangible steps a country team agrees upon to improve national cancer control planning within each priority action area.
Country
Priority Action Areas Identified
Fiji 1. Improve management of care by building
cross-disciplinary support through tumor board meetings;
2. Conduct leadership training for oncology nurses to strengthen cancer care management;
3. Develop a coordinated clinical and palliative care network, incorporating community-level health care;
4. Identify and evaluate technologies to improve patient tracking.
Indonesia 1. Implement a population-based cancer registry,
starting withJakarta and Jogjakarta;
2. Improve implementation of comprehensive cancer services guidelines.
Myanmar 1. Develop a comprehensive National Cancer Control
2. Strengthen and improve cancer registries;
3. Mobilize resources to implement the National Cancer Control Plan;
4. Strengthen human resources through training.
1. Finalize the National Cancer Control Plan by strategizing with stakeholders and seeking government approval;
2. Implement the National Cancer Control Plan and evaluate progress.
1. Finalize the Philippine Multi-sectoral Strategic Plan for the Prevention and Control of NCDs;
2. Strengthen cervical cancer screening through visual inspection with acetic acid;
3. Strengthen cancer registration and reporting of cancer registry data.
Thailand 1. Conduct palliative care training and implement
palliative care services in regional cancer centers;
2. Pilot a clinical breast exam screening program in one province in Thailand.
Vietnam 1. Convene a new National Steering Committee on
Cancer;
2. Enhance mass media cancer education programs;
3. Improve cancer registries by assessing data quality, standards, and regional variation of mortality;
4. Expand palliative care to the district level by creating training programs for clinical staff on how to prescribe and administer at the provincial level.
Papua New Guinea
Philippines
all participants and represent a key opportunity for international partners.
Coordination and enhanced contributions by stakeholders to maximize resources was identified as a key opportunity by countries. Malaysia highlighted diverse health financing mechanisms and partners as an important strategy to maximize resources. Myanmar discussed coordination of domestic and foreign contributors to ensure collaboration toward priority goals. Thailand noted recent improvements in coordination of the Thailand Cancer Service Plan, developing strategic cancer control plans for each regional health area and building a database to track personnel, equipment and treatment capacity.
Thailand also highlighted the important role of coordinating with CSOs, which play a strong role in cancer prevention in the country. Papua New Guinea stressed the same, since CSO leadership in the country has successfully elevated cancer control as a national priority and helped push passage of national tobacco
control policies. Clear lessons emerged regarding stakeholder coordination, including the need for: (1) integrated planning across sectors to ensure stakeholders are effectively working toward common goals; (2) well-articulated commitments from stakeholders; and (3) accountability for quality and outcomes.
Most of the participating countries included cancer registries as a priority. Fiji reported the launch of their cancer registry since participating in the 2014 Pacific Phase I Forum and provided important insight for other countries in implementing a tailored data collection system. Vietnam reported registry improvements at the provincial level by providing CanReg5 [4] training and financially supporting registry staff. Indonesia highlighted cancer registry strengthening as a priority area in their action plan and have strengthened work on a population-based registry during the APLF2 follow-up period. While a Global Initiative for Cancer Registry Development regional hub exists in Mumbai, India for cancer registry support in Asia, the hub is limited in its ability to serve such a large region. As such, cancer registry and surveillance is another opportunity for regional coordination and support and in this vein, Thailand has stepped in to lead recent cancer registry trainings for Myanmar, Indonesia and Malaysia. In addition, China, NCI and other partners have supported surveillance training in Vietnam, Indonesia and the Philippines.
Overall, the APLF2 was an important opportunity for previous attendees from the Phase I Forums to regroup as country teams, highlight successes in cancer control planning and implementation, continue troubleshooting challenges and strategize for the future. Since each country's sociopolitical, economic and demographic context differs, participants gained exposure to a variety of successful approaches in cancer control planning. Ongoing communication with the country teams and partners during the APLF2 follow-up period has made it clear that there is a desire for continuation of the program within the region. In response to the sustained interest, a Phase III Forum is currently being planned with the aims of continuing regional information-exchange, coordination of
country and partner efforts and providing enhanced technical assistance in specific areas of country interest such as financial planning and data-driven decision-making for cervical cancer control.
Acknowledgments
The authors would like to thank the Union for International Cancer Control (UICC) for co-sponsoring the APLF2. We also would like to thank our partners at the International Atomic Energy Agency - Programme of Action on Cancer Therapy, Office of the U.S. Health Affairs Attaché in Papua New Guinea, Economist Intelligence Unit, National Cancer Centre Singapore, World Health Organization and the International Cancer Control Partnership. We are deeply grateful to the faculty who have served as subject-matter experts, facilitators and advisors for continued technical assistance with the participating country teams. We also thank Asia-Pacific country team members for their engagement in the APLF2 and their leadership in moving forward national cancer control planning their home countries.
References
[1] J. Ferlay, I. Soerjomataram, M. Ervik, R. Dikshit, S. Eser, C. Mathers, M. Rebelo, D.M. Parkin, D. Forman, F. Bray, GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide, International Agency for Research on Cancer, IARC CancerBase No. 11, 2012 (Accessed 02 December 2016) http://globocan.iarc.fr.
[2] World Health Organization, Cancer Control Knowledge Into Action: WHO Guide for Effective Programs—Planning, WHO Press, Geneva, Switzerland, 2006.
[3] P.C. Pearlman, C. Vinson, T. Singh, L.M. Stevens, B. Kostelecky, Multi-stakeholder partnerships: breaking down barriers to effective cancer-control planning and implementation in low- and middle-income countries, Sci. Dipl. 5 (2016).
[4] International Association of Cancer Registries, CanReg5 Open Source Cancer Registry Data Software, 2016 (Accessed 02 December 2016) http://www.iacr. com.fr/index.php?option=com_
content&view=article&id=9:canreg5&catid=68&Itemid=445.
