INDONESIAN CANCER CONTROL PROGRAMs (ICCPs) 2010-2014

WHO highly recommendation

Background The global burden of cancer continues to increase largely because of the aging

and growth of the world population alongside an increasing adoption of cancer-

causing behaviors, particularly smoking, in economically developing countries.

Based on the GLOBOCAN 2008 estimates, about 12.7 million cancer cases and

7.6 million cancer deaths are estimated to have occurred in 2008; of

these, 56% of the cases and 64% of the deaths occurred in the

economically developing world. (CA Cancer J Clin 2011;61:69–90)

There are 3.6 million males and 4.0 million females living with cancer in these

Asian countries. In most of the Asian countries, cancer of the colon and rectum is

the mostcommon among male cancer survivors; among female survivors, breast

cancer is the most common in most Asian countries.

GLOBOCAN estimated 292.629 cancer cases and 214.626 cancer deaths in

Indonesia in 2008.

Following Minister of Health Decree No. HK.03.01/160/I/2010 about

Strategic Planning of Ministry of Health 2010-2014, Ministry of Health has

developed National Plan on Cancer Control, named Indonesian Cancer

Control Program (ICCP) 2010-2014.

Definition• WHO defined National Cancer Control Program is a public

health program designed to reduce the number of cancer cases and deaths and improve quality of life of cancer patients, through the systematic and equitable implementation of evidence-based strategies for prevention, early detection, diagnosis, and palliation, making the best use of available resources.

• A comprehensive national cancer program evaluates the various ways to control disease and implements those that are the most cost-effective and beneficial for the largest part of the population. It promotes the development of treatment guidelines, place emphasis on preventing cancers or detecting cases early so that they can be cured, and provide as much comfort as possible to patients with advanced disease.

Global Strategy

WHA Resolution1. To collaborate with the Organization in developing and reinforcing

comprehensive cancer control programmes2. To set priorities based on national burden of cancer3. To integrate national cancer-control programmes in existing health

systems

WHO Guideline on Cancer Control1. Prevention2. Early Detection3. Diagnosis and Treatment4. Cancer Surveillance5. Research: (Lab, Epidemiological, Clinical, Psychosocial and behavioral,

health system and health policies)6. Palliative Care7. Support and Rehabilitation

World Cancer Declaration (UICC)Priority action: 1. Health Policy2. Cancer Prevention and Early detection3. Cancer Treatment

Strategy (to be adopted)

Existing Cancer Control Program

Early Detection-Female Cancer Program (FcP) has developed cervical and breast cancer screening program(opportunistic)

Prevention-Guidelines of risk factors control-Promotion and Campaign on cancer prevention-Advocating tobacco control

Diagnosis and Treatment

- 14 Center of Pathology- 10 Center of Radio

Oncology- 21 Center of

Radiotherapy- 16 LINAC, 17 Telecobalt

Surveillance and Registry- Semarang pop based CanReg (1970)- Pathological based in 13 Pathology center (1987)- Hosp based CanReg in 40 Hospitals (as model) in

Jakarta (2006-2009)- Jakarta Cancer Registry (2009– now)

Palliative Care-Guideline of Palliative care in hospital

Support and Rehabilitation

-Free homestay and education for childhood cancer patients (NGOs, group of survivors)

Research-Riskesdas

Vision and Mission

Vision:Self motivated people to live healthy life without cancer

Mission:1. Increase Indonesian People health status

through community empowerment2. Protect Indonesian people from cancer by

providing comprehensive, distributed, high quality, and equal health care

3. Ensure availability and distribution of human resources of cancer control

4. Create good governance on cancer control

Goal and Objective (1)Goal:To enhance cancer prevention and control in Indonesia

Objective:1. Reducing the overall incidence and impact on the

Indonesian population2. Reducing health inequalities relating to cancer and

barriers to cancer services by providing access especially for poor people

3. Strengthening health promotion so that as many of the population as possible enjoy cancer-free lives

4. Ensuring timely diagnosis for those with cancer and timely access to high-quality care throughout their experience of cancer

5. Assisting those with cancer, their families to fully participate in all decision making related to their treatment and care

Goal and Objective (2)Goal:To enhance cancer prevention and control in Indonesia

Objective:6. Ensuring careful planning and appropriate priorities

by making the best use of existing resources and identifying where additional resources are needed

7. Ensuring the effectiveness of cancer control through research activities

8. Furthering the development of the cancer control workforce and increasing specialist training opportunities

9. Regularly monitoring cancer control activities to ensure they are effective and remain effective

10.Regulating of nuclear energy use on cancer diagnostic and therapy

Indonesia Cancer Control Program 2010-2014

1. Prevention

2. Early detection and screening

3. Diagnosis and Treatment

4. Surveillance and Cancer Registry

5. Research

6. Palliative Care

7. Support and Rehabilitation

1 Strengthening policy and commitment

The commitment will be developed by advocacy attended by all stakeholders.

2 Promotion and Campaign

Should be done massively and continually. Distributed to all province in Indonesia and publish in electronic media.

3 Development of Guideline

Review and improve national guideline of cancer control and develop technical guideline of risk factor control, community empowerment, and cancer prevention.

4 Human Resources Development

Hold training of cancer control management and cancer preventive promotion also technical assistant for cancer control provider.

5 Partnership Consist of government - non gov sector in international, national province and municipality level.

6 Community Empowerment

Will train cadres in cancer prevention strengthening PosKesDes and PosBinDu

7 Insurance Try to include the vaccination in insurance

8 Planning Process Will hold meeting, workshop, and socialization on developing plan on cancer prevention and control

9 Monitoring and Evaluation

All existing cancer control activities will be controlled and evaluated at national, provincial, and district level,

2. Early detection and screeningObjective:

To strengthen effort on cancer prevention through legal approach behavioral change, vaccination, local participation, and community empowerment.

Program :

1 Assessment The assessment will cover human resources, drug availability, and facility & equipment

2 Strengthening policy Nat guideline of diag and treat, cancer services and hosp stratification

3 Supply of diagnostic and treatment facilities

a. Diagnostic facility (Rad, Nuclear med, Path, Mol diag, Lab)

b. Treatment facility (Surge, Radth, Chem, Nuc med) I’ntl standart

c. a dan b with WHO prequalificationd. Brachytherapye. Research on a.b.c.d

4 Supply of affordable drug of cancer Get adequate medication quality and quantity

5 Regulating of nuclear energy use License of nuclear energy use (QA-QC) by BAPETEN

6 Calibration and Standardization

All facility in diagnostic and treatment will be calibrated and standardized

7 Clinical training and research program HRD should be trained well

3. Diagnosis and TreatmentObjective:

To provide affordable, high quality, distributed diagnosis and treatment facilities to all cancer patients in Indonesia

Program :

4. Surveillance and Cancer RegistryObjective:

To develop sustainable cancer surveillance and use its results as source of information on planning, monitoring, and evaluating cancer control program.

Program :1 Establishing legal

aspectMinistry of Health Decree of National Cancer Registry team and Provincial health office decree on provincial/Regional Cancer Registry team

2 Developing guidelines Develop guidelines of cancer registry, modules of cancer registry trainings and instrument of monitoring and evaluation

3 Developing National Cancer Surveillance and Registry

- Establish National Cancer Registry team and 12 Regional Cancer Registry team

- As part of Non Communicable Disease (NCD) Control, surveillance cancer will be a part of NCD surveillance.

We will develop surveillance of tumor integrated NCD surveillance

4 Human Resources Development

- Capacity building of CanReg (management and operational)

- MOT National Cancer Registry- Training of CanReg- Training of Surveillance of tumor (integrated NCD

surveillance)

5 Networking - International (IARC and IACR) - Regional Asia Pacific (Asian Cancer Registry Network)- National (National network on Cancer Registry)

6 Monitoring and Evaluation

- Visiting Regional Cancer Registry- Evaluating in Regionals and National by annual workshop

Developing National Cancer Surveillance and Registry

POPULATION BASED CANCER

REGISTRIES

National Cancer Control Institute

DG of Health Effort Care,

Ministry of Health

Hospitals

Division of Cancer Registration and

Surveillance

ClinicsInsurance

s-

Jamkesmas

- Askes-

Jamsostek

- Private

DG of Disease Control and

Environmental Health,

Ministry of Health

Dinas Kesehatan

PrimaryHealthCare

Traditional Medicine(BATRA)

Cancer registration may be defined as the

process of continuing, systematic collection of data

on the occurrence and characteristics of reportable

neoplasm

Cancer registry is in the office or institution which attempts to collect, store,

analyze and interpret data on persons with cancer.

The main objective of the cancer registry

• To collect and classify information on all cancer cases in other to produce statistics on the occurrence of cancer in a defined population and

• To provide a framework for assessing and controlling the impact of cancer on the community

The cancer registry is an essential part of

any rational program of cancer control.

Its data can be used in a wide variety of

areas of cancer control ranging from etiological

research, through primary and secondary

prevention to health-care planning and patient

care.

The cancer registry is an essential part of

any rational program of cancer control.

Its data can be used in a wide variety of

areas of cancer control ranging from etiological

research, through primary and secondary

prevention to health-care planning and patient

care.

The Role of Cancer Registries in Cancer Control Program

The Role of Cancer Registries in Cancer Control Program

Ministry of Health

Ministry of EducationInternational Collaboration

National Program, Research, Education in Cancer

National Tumor Board

Dharmais Cancer Hospital / National Cancer CenterResearch Cancer Center 2012 National Cancer Registry (Urban Area)Comprehensive Cancer Center 2014 National Cancer Registry (Pilot Project in Rural Area)

National Cancer Center2015-2019

NationalCancer Research

Center

AffiliatedHospitals

(10 Centers in Regional)

Division of National Cancer Registration

(Urban-Rural Area)and Surveillance

Division of Education and Training

NationalCancer

ResearchFoundation

Research Ethics Committee

AdvisoryCommittee

• Certified Cancer Education• Training & Education

University Society in Indonesia• Education Curriculum

Faculty of Medicine (S1,S2,S3) Faculty of Public Health (Majoring

Cancer Epidemiology) Faculty of Nursing (Oncology Nurse)

Indonesian Oncology Society (POI)

• Dissemination

Board Committee

Division of National Cancer Registration(Urban-Rural Area)

and Surveillance

Coordinator Regional Rural I(West Indonesia)

Coordinator Regional Rural II(Central Indonesia)

Coordinator Regional Rural III(East Indonesia)

Sub Division Of Regional Rural Area

Sub DivisionOf Regional Urban Area

Cancer Registry Society

University Society

Cancer Registry Network

Coordinator Regional Urban I(West Indonesia)

Coordinator Regional Urban II(Central Indonesia)

Coordinator Regional Urban III(East Indonesia)

Board Committee

Pre-clinical phase Pre-clinical phase Clinical phase Clinical phase

ExposureExposure

Onset ofdiseaseOnset ofdisease

Earlydetection

Earlydetection

Onset ofsymptomsand/or signs

Onset ofsymptomsand/or signs

D1 CureD1 Cure

D2 DisabilityD2 DisabilityD3 DeathD3 Death

AA BB CC

PrimarypreventionPrimaryprevention

SecondarypreventionSecondaryprevention

TertiarypreventionTertiaryprevention

------------------------------------------------------------------------ ------------------------------------------------------------

5. ResearchObjective:

To obtain scientific information on cancer as evidence of cancer control program in all aspect

Program :

1 Legal aspects Develop ethical board

2 HRD Establish Board of Cancer Research

3 Developing guideline

Policy, strategy, and priority of research on cancer

4 Research on Cancer Epidemiology

Will be connected to cancer registry or independently. Focus on risk factors, implementation HPV vaccination, survival, cervical and breast cancer, cause of deaths.

5 Research on Molecular Epidemiology

Focuses in 10 top leading cancer in Indonesia

6 Clinical Trial Developed on top 10 leading cancer

Partners

Indonesian Government:- Ministry of Education- Ministry of Religion- Ministry of Research and - Technology- National Atomic Energy Agency (BATAN)- Nuclear Energy Regulatory Agency (BAPETEN)

International Organizations:- UICC (Union International Cancer Control)- WHO (World Health Organization)- IAEA (International Atomic Energy Agency)- IARC (International Agency for Research on Cancer)- IACR (International Association of Cancer Registries)

Non-Governmental Organization- YKI (Yayasan Kanker Indonesia)- PKTP (Pengendalian Kanker Terpadu Paripurna)- YKAKI (Yayasan Kasih Anak Kanker Indonesia)- YOAI (Yayasan Onkologi Anak Indonesia)- MPI (Masyarakat Paliatif Indonesia)- FcP (Female Cancer Program)- CISC (Cancer Information and Support Center)- JHPIEGO (Alliance of Jhon Hopkins University)

Professional Societies:

POIPOGIHOGIPORIPDSRIPDPIPDPIPERABOIIAPIJNPKIDIIBIPPNIHOMPEDINIKAFMIPKNIIAKMI

The Declaration calls on the world to take immediate steps to reduce the global cancer burden by committing to the 11 Declaration targets and providing resources and political backing for the priority actions need to achieve them.

http://www.uicc.org/declaration/sign-declaration-thx

Thank you