National Cancer Control Programmes - Planning, Implementation, Monitoring and Evaluation

8/8/2019 National Cancer Control Programmes - Planning, Implementation, Monitoring and Evaluation

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National Cancer Control Programmes

Planning, implementation, monitoring and

evaluation

Dr D. Maxwell Parkin

University of Oxford, UK


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Priorities in cancer control

1. Prevention

2. Early detection3. Treatment

4. Palliative care


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A public health programme designed to reducethe incidence and mortality of cancer and

improve the quality of life of cancer patients

CANCER CONTROL PROGRAMME

It works through the systematic and equitableimplementation ofevidence-based strategiesfor prevention, earlydetection, diagnosis, treatment, and palliation


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5 steps of cancer control planning

Assess needs and capacity

Decide approach to planning Develop the plan

Implementation

Evaluation


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Measuring

Burden of cancer

Past trendsFuture projections

identifying the health problems,

determining priorities for preventive and curative programmes

NEEDS ANALYSIS: where are we now?


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INDONESIA: Cancer cases, 2002

25%

15%

9%8%6%5%

4%

3%

3%2%

Breast

Cervix uteri

Colon and rectum

Ovary etc.

Lung

Corpus uteri

Thyroid

Non-Hodgkin lymphoma

Leukaemia

Liver

19%

12%

11%

6%7%

6%

5%

4%

3%

2%

Lung

Colon and rectum

Liver

Prostate

Non-Hodgkin lymphoma

Nasopharynx

Leukaemia

Bladder

Stomach

Oral cavity & pharynx(excl NPC)

Males 80,000

Females 102,000


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Trends in Colon Cancer Incidence: ASIAAge Standardised Rate (World), MALES

SingaporeChinese

Hong Kong

Osaka

Manila

Bombay

.

.

..


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PLANNING NCCPsI DEFINING THE MAGNITUDE OF THE PROBLEMBurden of cancerPast trendsFuture projections

II REVIEW PROFILE OF RISK FACTORS


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Major causes of cancer: World 2001 (GBD 2006)

0 10 20 30

Pollution

Physical inactivity

Overweight

Alcohol

Diet

Infection

Tobacco

Percent of all cancer

Bar 1

H. pylori

HPV

Hepatitis viruses

Low fruit & veg.

Bar 6


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PLANNING NCCPsI DEFINING THE MAGNITUDE OF THE PROBLEMBurden of cancerPast trendsFuture projections

II REVIEW PROFILE OF RISK FACTORS

III ASSESSMENT OF CAPACITYIV SETTING PRIORITIES FOR INTERVENTION


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NCCP : intervention stategies

Prevention

Early detection

Diagnosis and Treatment

Palliative care


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Activities of a Cancer Control Programme

For each:

Identify the immediate target

Estimate the impact (quantify reduction in

incidence and mortality)

Estimate the resources needed

Estimate the cost of the activity


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(PRIMARY) PREVENTION

Occupation

..

Tobacco

Infection

Diet/Obesity/Physical exercise

Reproductive factors

AvoidanceImmunisationTreatment


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Male FemaleEastern Africa 0.0 0.0Middle Africa 1.7 0.0Northern Africa 14.8 0.0

Southern Africa 18.7 3.4Western Africa 0.0 0.0Carribean 22.4 6.3Central America 14.8 3.4Temperate S. America 25.6 3.2Tropical S. America 17.1 4.0Northern America 24.5 16.5

China 7.0 4.6Japan 28.0 10.6Other East Asia 35.4 10.8South-Eastern Asia 27.8 7.4South-Central Asia 13.5 0.0Western Asia 27.9 0.2Eastern Europe 42.3 4.1Northern Europe 25.4 11.4

Southern Europe 36.5 3.0Western Europe 29.4 4.4Australia/New Zealand 17.9 8.6Melanesia 0.7 0.0Micronesia/Polynesia 29.7 11.1

WORLD 27.9 5.9

Developed countries 30.8 9.1Developing countries 25.2 3.1

Percentages of all cancer cases attributable to tobacco smoking

INDONESIA: Tobacco Use in 2005 (WHO InfoBase)

daily cigarette use 53.6% males, 2.8% females

daily smoking tobacco 58.4% males 3.2% females


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INTERVENTIONS TO REDUCE DEMAND FOR TOBACCO

TOBACCO TAXATION

RESTRICTIONS ON SMOKING

BANS ON ADVERTISING AND PROMOTING

HEALTH INFORMATION AND COUNTER-ADVERTISING

SMOKING CESSATION TREATMENTS

INTERVENTIONS TO REDUCE SUPPLY OF TOBACCO

FRAMEWORK CONVENTION ON TOBACCO CONTROL


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LIVER CANCER & Hepatitis virusesIndonesia

HBsAg positive ~9%

Anti-HCV positive ~2%

HBV(45%)

HCV

(10%)

Both(18%)


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INDONESIA: Prevalence of overweight and obesity (2005)


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CANCER CONTROL

Prevention

Screening & Early Detection

Treatment

Rehabilitation / Palliation


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Early detection

Screening: organised efforts to detect early disease in

asymptomatic populations by mass application of simpletests at regular intervals.

Early clinical diagnosis: detection of early clinical

stages of disease in symptomatic subjects.


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Screening programmes should be undertaken only when

their cost effectiveness has been demonstrated, sufficient resources are available to adequately cover the target group

with screening tests, to investigate those with positive tests, and toprovide treatment and follow-up care,

the incidence of disease is high enough to justify the efforts and costsof screening

0 5 10 15 20 25 30 35

Australia

Norway

Indonesia

World

Korea, Republic

Poland

Less developed countries

Thailand

Philippines

Bangladesh

India

Cancer of

cervix


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Methods of screening for breast cancer

1. Imaging: mammography

2. Physical examination

3. Self-examination


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INDONESIAa mammography screening programme?

17 million women aged 45-64.

Screening every two years would require some 6-7 million tests every year

Of these, some 3-8% (say 300,000) would require follow up investigation for an

abnormal mammogram.

Each year, there are some 7-8000 deaths from breast cancer at ages 45-

64, and 2500 over the age of 45.

A screening programme is expected to reduce mortality by ~ 20%

The maximum saving from this huge input of resources would therefore

be 2000 deaths


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Early clinical diagnosis:

The detection of early clinical stages of disease insymptomatic or high-risk subjects. requires:

Increasing awareness of the population of earlywarning signs of the disease

orienting health personnel towards early diagnosis ofcommon forms of curable cancers

empowering them to seek early clinical attention.

ALTERNATIVE:

MANILA PHILIPPINES


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MANILA, PHILIPPINES

Breast cancer by stage at diagnosis1995

II 50%III 23%

IV 8%

Unk 13%

In situ1% I 4%

Stage II+:94%

P f i d l f h l (NPC) b d


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Devi, B. et al. Ann Oncol 2007 18:1172-1176; doi:10.1093/annonc/mdm105

Percentage of patients presented at late stage for nasopharyngeal cancer (NPC), breast andcervix in Department of Radiotherapy and Oncology (DRO), Sarawak General Hospital (SGH)

(1991-1999) , following a programme of training of health personnel to improve their skills in early

detection of these cancers (1991-1996), and, at the same time, a public education programme to raise

awareness of these diseases, and their early signs and symptoms


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Priorities in cancer control

1. Prevention

2. Early detection3. Treatment

Cancer therapy often relatively expensive

- making the best use of available resources


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Two recommendations from the Institute of Medicine committee on

cancer control in low and medium income countries, 2006

Countries should consider establishing a government-supported cancer

center of excellence that provides resource-level appropriate services to

the public and acts as a reference point for national cancer control.

Resource-level specific guidelines for the overall management of major

cancers for which treatment can make a substantial difference in a

meaningful proportion of patients should be developed


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Palliative Care

Management of pain

(and otherproblems, physical, psychosocia

l and spiritual)

Concerned with QUALITY OF LIFE

Prevent & relieve sufferingthrough:


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Surveillance is an essential component of a NCCP

Setting priorities

Setting objectives

Evaluating outcome

Comparing with resource inputs


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EVALUATION OF

Effectiveness

Does the programme achieve its objective?

Efficiency

Costs in relation to outcome


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Thank you

National Cancer Control Programmes - Planning, Implementation, Monitoring and Evaluation

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