The necessity of NCCP10/08/17Health
PEN explores the importance of the implementation of National Cancer Control Programmes (NCCP), as outlined by the World Health Organization.
The National Cancer Control Programme (NCCP) is a public health programme designed by the World Health Organization (WHO) to reduce the number of cancer cases and deaths, as well as to improve quality of life amongst cancer patients. Through the national implementation of systematic, equitable and evidence-based strategies for prevention, early detection, diagnosis, treatment and palliation using available resources, it is intended to achieve such aims. WHO believes that, regardless of resource constraints, a well-conceived and well-managed ‘NCCP helps reduce the cancer burden and improve services for cancer patients and their families’, as quoted on their website.
Cancer was the second leading cause of fatality across the globe in 2012, with 8.2 million recorded. The annual number of new cases is anticipated to rise from 14.1 million in 2012 to 21.6 million in 2030. Speaking upon the release of his 2016 report ‘Cancer prevention and control in the context of an integrated approach’, Dr Etienne Krug, director of the WHO Department for the Management of NCDs, Disability, Violence and Injury Prevention, said in a press release: ‘Cancer should not be a death sentence for anyone anywhere. The capacity exists to reduce the burden of cancer and improve the survival and quality of life of people with cancer. WHO is pleased to have a renewed mandate to support countries to ensure access to cancer care for all.’
The benefit of an NCCP is to provide the most efficient means of attaining a substantial degree of cancer control, despite resource constraints. WHO recommend that an NCCP be established in areas where the burden of the disease is significant, an evident rising trend of cancer risk factors, or a need to make the most efficient use of limited resources. Concerns which have led to the initiation of an NCCP centre upon resources being used inefficiently.
WHO outlines the crucial principles of a national cancer control programme within the ‘National Cancer Control Programmes: Policies and managerial guidelines’ second edition as goal-orientated, focused on the needs of the people, and a systematic decision making process. Moreover, the monograph places emphasis on a systemic and comprehensive approach, leadership, partnership, and continuous improvement, innovation and creativity.
Prevention and control
A survey conducted in 2001 by the World Health Organization assessed the national capacity for the prevention and control of cancer, amongst other non-communicable diseases, in 167 countries. The findings indicated that nearly half of the respondent countries had a cancer control policy or plan. Around two thirds of the countries identified the availability of national guidelines for prevention, and nearly half reported that cancer management guidelines had been produced.
In order to initiate the establishment of an NCCP, WHO provides recommendations from the pre-planning stage through to implementation. They suggest that: ‘All key stakeholders should be involved early in the planning stages, and national leadership is needed throughout the process. Decision makers can be reassured that a cancer control plan will not create a costly vertical programme, but should be integrated with non-communicable diseases and other programmes to make better use of available resources.’
The translation of a cancer control plan into action necessitates competent management and leadership, which are vital to ensuring that accurate methods are applied in the right place and at the same time, with the appropriate people to mobilise resources and analyse progress. In order to implement NCCPs, WHO recommends that interventions be conducted ‘in a stepwise approach’, to focus on improving the organisation of resources. Stemming from successful demonstrations, more resources would be justified, consequently expanding the programme.
In April 2017, the WHO released a report on ‘Cancer prevention and control in the context of an integrated approach’, which considers trends, NCCP plans, prevention, diagnosis, screening and treatment, as well as responses, recommendations and actions. A 2015 country capacity survey for non-communicable diseases highlighted that 87% of 177 respondent member states said that they had either a policy, strategy or action plan for all, or some, cancers. 68% reported that the policy, strategy or action plan was in effect. The organisation also highlights that ‘only 5% of global resources for cancer prevention and control are spent in low- and middle-income countries, despite the majority of preventable deaths’.
To counterbalance such outcomes, WHO recommends that the risk factors for cancer should be reduced through policies and programmes, improved access to time-efficient diagnosis, and treatment. Furthermore, compliant countries should optimise existing human resources, as well as anticipate the future requirements for cancer prevention and control. Concluding upon the actions, WHO calls for data improvements in order to efficiently inform policy and decision making.
In 2007 Ireland established a National Cancer Control Programme in response to WHO recommendations, and Professor John Kennedy, chairman of the steering group, noted the move as pivotal. A new cancer strategy has since been developed, recognising the need to set short-, medium- and long-term goals in addressing deficiencies in specialist cancer nursing whilst strengthening the role of the NCCP. Furthermore, the country aims to develop an intensive electronic patient record system, whilst the steering group has decided to revisit recommendations in 2021 to map realistic goals for the concluding stages of the strategy.
‘A Strategy for Cancer Control in Ireland’ – produced in 2006 by the National Cancer Forum, Ireland – aimed for Ireland to develop ‘a system of cancer control which will reduce our cancer incidence, morbidity and mortality rates relative to other EU-15 countries by 2015. Irish people will know and practise health-promoting and cancer-preventing behaviours and will have increased awareness of, and access to, early detection and screening. Ireland will have a network of equitably accessible state-of-the-art cancer treatment facilities.’ Currently, the centralisation of surgical cancer services is yet to be fulfilled.
Hungary’s healthcare commitment
Co-ordinated by the National Institute of Oncology (NIO), Hungary, in 1993, a National Cancer Control Programme was established by an expert panel. In 2006 this plan was updated continuously and presented at the request of the then health minister Jenő Rácz. The enforcement of the plan was a process of co-operation between the Ministry of Health, prominent representatives of the NIO and the discipline of oncology (primarily of the Board of Oncologists). The updated Cancer Control Programme was officially launched by the then prime minister, Ferenc Gyurcsány, on 3 February 2006, when he released the White Book.
In a 2006 WHO-delivered survey, Dr Miklós Kásler, on behalf of Hungary, reinstated the Hungarian dedication to ‘further development of Cancer Registry, primary and secondary prevention, translation diagnostic, complex oncotherapy, rehabilitation, [and the] establishment of the structure of hospice care’. Screening strategies from the previous plan were implemented in 2006, including breast screening and the installation of colorectal screening. Whilst in therapy, comprehensive chemotherapy and the development of radiotherapy was established under the 1993 plan.
This article will appear in Pan European Networks: Health 2, which will be published in August.