The role of cancer centres in advancing cancer control and health systems
Leading work in global cancer has recommended that every country aim to have at least one publicly supported “cancer centre of excellence” that advances the broad objectives of cancer control, provides exemplary patient care appropriate to local circumstances, and concentrates a country’s specialized human and technical resources.1-3
The broad scope of care and centralization of expertise within a cancer centre enable complex models of care delivery by a wide range of providers from a number of disciplines and professions. In addition to providing vital cancer care services to patients, the cancer centre delivers many of the components of cancer control and plays an important role in advancing cancer control and health systems. The centre can:4
- Catalyze the development of effective cancer control. The critical mass of clinical and core services / infrastructure and expertise available within a cancer centre provide an effective and efficient locus for quality cancer control. Cancer centres can also lead the development of regional cancer systems, act as focal points for cancer control nationally and provide a credible public voice to national cancer control efforts.1
- Guide and support the development of effective health systems by modelling quality clinical management practices that can be transferred to all healthcare services.
- Educate a country’s healthcare professionals, by providing professional and multidisciplinary/interprofessional team-based training. Other hospitals, community clinics and primary care can provide training placement opportunities. 5
- Contribute to global efforts to improve health.6 For example, international health organizations that cross national boundaries can benefit from cancer centre participation in areas such as research and development, and sharing of information for ongoing learning.7, 8 As well, established centres can twin with less developed countries to facilitate the development of cancer centres and to help achieve a country’s cancer goals.1, 2
Essential elements of the cancer centre
There are numerous examples of thriving cancer centres and programs around the globe as well as examples of cancer centres with serious gaps in services, technology and operations.9 While there are descriptions of factors that may influence the development of cancer centres, there is a dearth of robust guidelines or frameworks that detail the elements the must be in place to ensure a cancer centre’s optimal functioning and enable the delivery of comprehensive, high-quality care.9 In the absence of such guidelines, gaps can occur that result in poor quality of care and inferior outcomes due to a lack of co-ordinated services, inadequate infrastructure and inefficient management.
Cancerpedia offers a framework for considering the functions essential for a comprehensive cancer centre. At the core of cancer care, we describe the criteria and the principles of clinical management, the roles and responsibilities of the healthcare team, and strategies to engage patients in their care. The execution of clinical care plans requires availability of clinical services to deliver diagnostics, including medical imaging and laboratory and pathology services, as well as cancer treatment, including surgery, radiotherapy, chemotherapy and palliative care. Supportive care, pharmacy and emergency care help round out the full spectrum of cancer care. Supporting these are a wide range of core services and infrastructure, including infection prevention and control, physical facilities and support services, equipment and technology, health records, human resources and others that allow the cancer centre to operate safely and effectively. The framework also presents guidelines for governance that ensure oversight and quality, describes the critical need for integrating education and research, presents best practices for engaging in philanthropy, and outlines the need for integration with community care.
While the entirety of this framework represents an ideal state to achieve high-quality cancer care should aspire to, it is important to note that the individual elements of the framework can be developed in a stepwise fashion and over time. Resource limitations should not entirely preclude development. It is also important to note that the framework is relevant regardless of how the cancer centre is organized (e.g., as a free-standing and dedicated site, a cancer program in an academic health sciences centre or hospital, or a group of hospitals providing an integrated program).
- Sloan FA, Gelband H. Cancer control opportunities in low-and middle-income countries. Washington, DC: National Academy Press; 2007.
- Gralow JR, Krakauer E, Anderson BO, Ilbawi A, Porter P, Gospodarowicz M, et al. Core elements for provision of cancer care and control in low and middle income countries. In: FM K, JR G, R A, A B, editors. Global task force on expanded access to cancer care and control in developing countries. Closing the Cancer Divide: An Equity Imperative. Boston, MA: Harvard Global Equity Initiative; 2012.
- Gralow JR Knaul FM, Atun R et al. Closing the cancer divide: overview and summary. 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; 2012c. p. 3-28.
- Gospodarowicz M, Trypuc J, D‘Cruz A et al. Cancer services and the comprehensive cancer center. In: Gelband H JP, Sankaranarayanan R et al., editor. Disease control priorities. 3 ed. Washington, D.C.: The World Bank; 2015. p. 195-210.
- Debas HT, Gosselin R, McCord C et al. Surgery. In: Jamison DT BJ, Measham AR et al, editor. Disease control priorities in developing countries. 2 ed. Washington, DC: Oxford University Press and the World Bank; 2006. p. 1211-28.
- Frenk J, Moon S. Governance challenges in global health. New England Journal of Medicine. 2013;368(10):936-42.
- Blanchet N, Thoma M, Atun R et al. Global collection action in health: the WDR+20 landscape of core and supportive functions. 2013.
- Jamison DT, Frenk J, Knaul F. International collective action in health: objectives, functions, and rationale. The Lancet. 1998;351(9101):514-7.
- Sirohi B, Chalkidou K, Pramesh CS, et al. Developing institutions for cancer care in low-income and middle-income countries: from cancer units to comprehensive cancer centres. Lancet Oncology. 2018;19.