The importance of a health system perspective
Comprehensive cancer centres or programs exist as part of a broader healthcare system, in which a wide array of ever-changing, interrelated factors and relationships influence the ability and capacity to implement cancer control measures. To continue to be viable and consistently deliver positive outcomes, a cancer centre must critically assess its internal alignment and integration while simultaneously looking outward to improving the health system within which it operates. For example, investments in medicine and technology are unlikely to be fruitful if they are not introduced with an understanding of the broader healthcare system. Conversely, broader cancer control strategies – such as primary prevention, early detection and screening, and national regulations and accreditation standards – can result in earlier diagnoses, improved treatment outcomes and safer delivery of cancer services for patients.
Since the cancer control system in part of the larger health system, there are opportunities for synergies between functions and multiple disease programs.1 A diagonal approach recognizes the value of targeted action for individual diseases, such as cancer, as well as collaborative action where interrelationships exist between cancer and other diseases in the health system.
Integrating the cancer centre into the broader health system
Although the cancer centre may operate as an independent entity, it is most effective when integrated into a broader system of healthcare and cancer control. To improve cancer care for all, a variety of stakeholders must take co-ordinated action, including national policy-makers, regional health planners, academic societies, healthcare providers, and patients and civil societies.2 This allows for a number of synergies and opportunities to enhance care delivery at an individual and population level. In this way, cancer centres are also able to participate in shaping the development of regional cancer systems and influence decisions that affect national cancer control priorities.
For example, while primary prevention, early detection and screening programs may be provided by the cancer centre or primary care, their activities should ideally be based in information about the population’s current and predicted future burden of cancer, relevant risk factors and evidence relating to the efficacy of interventions on a broader scale. Population-based cancer registries are systems that collect, code and classify information about all cancers diagnosed within a defined catchment area. This rich repository of information is valued across the cancer control continuum, and plays a key role in not only defining and evaluating prevention priorities and screening programs, but in assessing the overall quality of cancer care in a population, studying the etiological aspects of cancer (i.e., the factors that produce or predispose individuals to get cancer), and conducting population-based research.
National cancer control strategies should ideally be based on a jurisdiction’s cancer burden, the prevalence of cancer risk factors, the skills and infrastructure available to implement plans, and the healthcare system and socio-economic environment.3 Cancer control strategies enable governments and organizations to set and measure progress towards targets for health improvement, and leverage a jurisdiction’s enablers, address its barriers, and maximize the use of existing resources to meet the needs of a population. Cancer strategies should include clear directions and priorities, service delivery and resource plans, policies, and provisions for advocacy efforts, information systems and funding. For more information about national cancer control strategies from around the world, see the Analysis of National Cancer Control Programme’s in Europe or the International Cancer Control Partnership.4, 5
Finally, licensing requirements, regulations and accreditation standards support national cancer control strategies and influence the development of policies, standards and best practices that govern cancer control activities and the safe delivery of cancer care services. Regulations and standards address such issues as carcinogenic exposure, the requirements and scope of practice of health and technical professionals, and the regulatory and accreditation requirements of health service organizations.
It is important to note that while it is desirable for cancer centre to operate as part of a broader cancer control system, the absence of such as system does not preclude cancer centre development. Cancer centres are powerful sources of cancer control in their own right; however, cancer patients undoubtedly benefit from population-level knowledge and programming.
- Alleyne G Knaul FM, Piot P et al. Health system strengthening and cancer: a diagonal response to the challenge of chronicity. In: Knaul FM GJ, Atun R et al. , editor. Closing the cancer divide: an equity imperative. Cambridge, MA: Harvard Global Equity Initiative/Harvard University Press; 2012b. p. 3-28.
- Prager GW, Braga S, Bystricky B, et al. Global cancer control: responding to the growing burden, rising costs and inequalities in access. ESMO Open. 2018;3(2):e000285.
- Union for International Cancer Control and Association of European Cancer Leagues. Supporting national cancer control planning: a toolkit for Civil Society Organisations (CSOs). Geneva: Union for International Cancer Control and Association of European Cancer Leagues; 2012.
- Atun R, Ogawa T, Martin-Moreno JM. Analysis of national cancer control programmes in Europe. London, England; 2009.
- International Cancer Control Partnership. [cited 2018 September 20]. Available from: https://www.iccp-portal.org/map.