Value of cancer control measures
6.5 Stepwise priorities in cancer control
Tier 1 Tier 2 Tier 3
Prevention WHO “best buys” WHO “good buys” Can include risk-adapted
strategies
Screening Cervical cancer screening and
treatment
Mammography-based screening
Colorectal cancer screening
Can include other evidence-based screening strategies
Pathology
WHO List of Essential In-vitro Diagnostics
Priority medical devices for cancer management
Can include selected molecular pathology services
Can include expanded molecular pathology services
Imaging
X-ray, ultrasonography, computed tomography (selected indications)
Broader use of computed tomography and selected nuclear medicine
Expanded nuclear medicine services and magnetic resonance imaging
Surgery For priority diagnostic, curative
and palliative interventions
Can be extended to more complex procedures
Minimally invasive procedures for broad indications
Radiation Therapy
Selected high-impact indications with technology of low complexity
Extended indications with higher complexity
All relevant indications from evidence-based, high-quality clinical guidelines at the highest level of complexity
Medicines WHO Essential Medicines List
High-impact threshold (informed by MCBS and other references)
Evidence-based impact threshold (informed by MCBS and other references as used in HIC)
Palliative care
Home-based essential interventions in primary care and select hospital-based services
Expanded hospital services
Can include broad inpatient and outpatient palliative care, including hospices
The readiness of the health system must be considered throughout step-wise implementation of cancer programmes: Are there a sufficient workforce, infrastructure and resources? Further, in line with UHC and the established principle of progressive realization, population coverage should be maximized and financial risk minimized before advancing to more complex services is considered (see also chapter 7).
Small-island states and countries with fragile health systems due to conflict or emergencies require different approaches to cancer control planning and priority-setting. Neighbouring small-island states, such as in the Pacific, often have similar cancer epidemiology, risk factors and capacity to respond. A recent analysis of Pacific island countries and territories found that few had public health programmes for cancer, including prevention, early diagnosis and palliative care (26). For countries with small populations and therefore small numbers of cancer cases, regional collaboration could augment capacity, timely access to care and allocative efficiency, particularly for capital expenditure (27).
In countries in conflict, the background burden of cancer persists and contribute significantly to the burden of disease (28). The challenges for cancer policy development and implementation include lack of data for planning, insufficient international support or commitment, geographical barriers to care and high financial and emotional burdens on refugees and displaced populations (29). Long-term political strategies and financial contributions are necessary to support service provision (Box 6.6) (30). In the short term, the priorities include coordination and knowledge-sharing among external partners working under national health agencies, strengthened early diagnosis (particularly health literacy and referral pathways) and palliative care. With the support of global stakeholders, these are achievable.
Ongoing conflict and more than 8 years of instability in Yemen have weakened the health system to the point of near collapse with deterioration of social safety needs, adverse health outcomes, and expansive health needs coupled by high out-of-pocket expenditure. Non-communicable diseases continue exert a significant burden in Yemen, even during this period of conflict, and are responsible for an estimated 70–80%
of deaths (31). In particular people with cancer, renal failure, and cardiovascular diseases have historically been unable to access services and as result become the silent victims of war.
Resources provided by Germany, Japan, Kuwait, Saudi Arabia, the United Arab Emirates and the United Nations Office for the Coordination of Humanitarian Affairs, has enabled WHO and local health authorities to ensure some assistance for cancer and dialysis patients. This support includes establishment of cancer registries to assess the burden and monitor implementation, incentives for 250
professional cancer health workers in 12 cancer care centres throughout the country, provision of mammography machines to Sana’a and Aden for earlier diagnosis and laboratory reagents for pathology.
In 2019 alone, approximately 31 500 patients, including almost 2000 children, received cancer care. In line with WHO’s mission statement, the most vulnerable are being served and protected from physical, emotional and financial harms through these services and global collaboration.
WHO believes that more investment in cancer care, such as provision of radiation therapy equipment is needed to guarantee multidisciplinary approach to achieve Universal Health Coverage for this category of patients (32).
Box 6.6. Cancer control in Yemen (32)
Section III 122
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