Comprehensive Cancer Control Plan 2018-2022

Objectives

Guam’s Comprehensive Cancer Control Strategic Plan 2018–2022 provides the island’s third cancer-control framework, building on earlier plans and a decade of coalition experience.[1]It envisions a cancer-free population that embraces healthy lifestyles and lives in a healthy environment, and seeks to reduce cancer incidence and mortality through public-private collaboration.[2][3]

• Reduce exposure to cancer risk factors, promote healthy behaviours, support early diagnosis and appropriate treatment, and strengthen survivorship, quality of life and palliative care.[1][3][4]
• Focus resources on lung, breast, cervical and colorectal cancers as immediate priorities, while treating liver and prostate cancer as intermediate priorities.[3][5]
• Use local data and evidence-informed interventions to achieve a sustainable, measurable reduction in Guam’s cancer burden within available resources.[2][3]
• Prevent and reduce cancer risks through vaccination, tobacco control, health education, policy change and environmental measures.[6][7]
• Increase completion of the human papillomavirus vaccination series among children aged 9–18 years by 10% by June 2022, and increase awareness and knowledge of colorectal and lung cancer prevention strategies by 5% for each condition.[6][7]
• Improve lung and colorectal cancer screening, including a target for 60% of healthcare providers to use United States standard lung cancer screening guidelines and targets to increase blood stool testing, colonoscopy and sigmoidoscopy uptake among adults aged 50–75 years.[8][9]
• Enhance survivor and family quality of life by establishing survivorship care plans at four cancer treatment centres and developing an advance directive tool or curriculum by 2022.[10][11]
• Advocate for policies, systems and environmental changes supporting prevention and quality of life across lung, breast, cervical and colorectal cancers, while increasing the community cancer advocate pool by 50% from baseline.[11]
• Improve collection and dissemination of quality cancer data, increase public awareness of cancer’s community impact by 30%, and use data to mobilise prevention and control support among 80% of policymakers by 2022.[4]

Implementation

Implementation relies on a community-driven coalition model involving public agencies, private organisations, health professionals, political leaders, schools, researchers, survivors, faith organisations and community members affected by cancer.[4]The Guam Comprehensive Cancer Control Coalition provides the coordinating platform, supported by the Department of Public Health and Social Services Comprehensive Cancer Control Programme, a Steering Committee and action-focused subcommittees.[1][2][12]

• Organise delivery through five action teams: Prevention; Screening, Early Detection and Treatment; Survivorship and Quality of Life; Policy and Advocacy; and Data and Research.[6]
• Use an inclusive planning process that reviewed the 2013–2017 plan, convened strategic planning workshops in February and June 2017, held monthly action-team meetings, and subjected proposals to community-based peer review.[3]
• Prioritise interventions according to disease prevalence and burden, community readiness, political support, health-system capacity, and the availability of effective prevention, diagnosis and treatment measures.[3]
• Align cancer-control activity with related local, national and regional initiatives, including the Non-Communicable Disease Prevention and Control Plan and the Diabetes Prevention and Control Plan.[3]
• Implement human papillomavirus vaccination through a dedicated workgroup and action plan, provider, parent and adolescent toolkits, community outreach, improved vaccine access, health-care champions, school-based support and professional education.[6][7]
• Deliver colorectal cancer prevention through a workgroup, action and communications plans, provider toolkits, public campaigns and engagement with clinics, laboratories, mobile health services, political leaders, survivors and surgery centres.[7]
• Reduce lung cancer risk through a Lung Cancer Prevention Workgroup, tobacco-cessation support for young people and adults, communications campaigns and action to reduce second-hand smoke exposure.[8]
• Strengthen screening by gathering baseline information from providers and insurers, disseminating screening guidance through professional bodies, distributing colorectal toolkits, promoting Colorectal Cancer Awareness Month and seeking insurance coverage for sigmoidoscopy and colonoscopy.[9]
• Introduce survivorship care plans by reviewing and piloting a model in one clinic, educating providers, conducting public outreach and extending implementation to four treatment clinics.[10]
• Develop advance-directive support by adapting an appropriate tool or curriculum, testing it through community focus groups, incorporating lived experience and working with policy advocates to promote use.[10][11]
• Build advocacy capacity through political mapping, letters of support, political champions, advocacy pledges, recruitment of public- and private-sector advocates and annual prevention and control training.[11]
• Expand data use by disseminating cancer survival and economic-cost reports, briefing policymakers, creating an online data and research inventory, updating Guam Cancer Facts and Figures and exploring data sharing with private insurers.[4]
• Monitor implementation through annual actions, time frames, named stakeholders and success indicators, with activities revised iteratively in response to progress, successes and failures.[4]Progress measures include vaccination completion, toolkit use, outreach events, provider education, tobacco cessation, smoke-free coverage, screening uptake, survivorship-plan coverage, advance-directive completion, policy adoption, advocate growth and public data availability.[6][7][8][9][10][11][4]
• Recognise limits in trend interpretation where Behavioural Risk Factor Surveillance System indicators were revised in 2016 and may not be directly comparable with the 2013–2017 baseline.[13][6]

Monitoring & Evaluation

Monitoring is embedded in the five-year cancer-control plan through action-team objectives, annual actions, timeframes, named stakeholders, baseline measures and progress indicators. The Guam Cancer Coalition coordinates implementation through a Steering Committee and subcommittees that generally meet monthly, while the plan is intended to be revised iteratively in response to progress, successes and failures.[4][12]

• Assess implementation through action-team reporting and refinement of objectives into Specific, Measurable, Achievable, Relevant and Time-bound formats, annual strategic actions and indicators. Reviews of the 2013–2017 plan drew on the Behavioral Risk Factor Surveillance System, Youth Risk Behavior Surveillance System, Guam Cancer Care, and the Screening, Early Detection and Treatment Action Team.[3][5][14]
• Track historical prevention performance against screening, education, physical-activity and environmental objectives. The earlier review found that mammography and Pap-test targets had not been met; colorectal screening and high-school physical-activity targets remained ongoing; cancer-prevention curriculum delivery and middle-school physical-activity targets were achieved; and playground-access action had not started.[5]
• Monitor screening and treatment delivery through provider and insurance baseline surveys, educational participation, mid-term assessments, revised plans and post-assessments of knowledge, awareness, practice and screening uptake. Relevant measures include provider adherence to United States Preventive Services Task Force recommendations, use of evidence-based tools, faecal occult blood testing, and sigmoidoscopy or colonoscopy history.[8][9]
• Measure human papillomavirus vaccination implementation through adolescent series completion, increases in children completing two- or three-dose vaccination, school vaccination champions, toolkit development and use, outreach activities, local professional conferences, and continuing education participation by health-care professionals.[6][7]
• Measure colorectal cancer prevention through workgroup participation, action-plan and communications-plan completion, toolkit dissemination, campaigns and partner engagement. Milestones include toolkit receipt by 95% of health-care providers and clinics, alongside intended post-assessment increases in colonoscopy uptake to 46% and sigmoidoscopy uptake to 7%.[7][9]
• Track lung cancer prevention using youth and adult tobacco-cessation attempts, population coverage by smoke-free ordinances, exposure to second-hand tobacco smoke, provider participation in lung-screening education and use of screening guidelines. The plan includes a target for at least 60% of providers to use United States standard lung cancer screening guidelines.[7][8][9]
• Monitor survivorship care through care-plan adoption, completion and implementation at four treatment clinics, public outreach reach, and professional and public knowledge. The stated target is for at least 80% of cancer patients at those clinics to have a survivorship care plan by the end of 2022.[10]
• Evaluate advance-directive work through focus groups, a written report and incorporation into clinic and hospital policies, with a 2022 utilisation target of at least 50% of cancer patients completing an advance-directive instrument.[10][11]
• Record policy and advocacy outcomes through cancer-prevention and control policy adoption, a baseline count of community advocates, annual membership growth and annual advocacy training.[11]
• Assess data and research outputs through public availability of cancer survival, economic-cost and facts-and-figures reports; policy briefings; an online cancer-data inventory; and a data-sharing Memorandum of Understanding with insurance agencies. The Data and Research Action Team also seeks a 30% increase in public awareness of cancer’s community impact and mobilisation of support and resources among 80% of policymakers by 2022.[4]

Reported earlier achievements include four cancer education activities by 2017, four policy or social and environmental activities per project year, eight policy advocates from diverse sectors, completed cancer-survival and economic-cost reports, an updated Guam Facts and Figures Report, and a feedback document evaluating five action teams. Uniform data standards and a prioritised list of coalition activities for evaluation remained ongoing.[15][13]Indicators revised in the 2016 Behavioral Risk Factor Surveillance System may not be directly comparable with 2013–2017 baseline data or later survey results.[13][6]The available material does not specify a comprehensive reporting schedule, evaluation design, surveillance governance framework or formal accountability process beyond designated stakeholders, indicators and progress tracking.[6][4]

Costing & Financing

Financial detail is limited. The plan identifies evidence-generation and coordination activities related to cancer costs, and acknowledges support through a Cooperative Agreement with the United States Centers for Disease Control and Prevention, but it provides no budget amount or overall financing framework.[4][12]

• Produce and disseminate an Economic Cost of Cancer analysis for Guam as part of the Data and Research Action Team’s delivery plan.[4]
• Explore a further cost-of-cancer report using private insurance data, with private insurance representatives identified as potential data-sharing stakeholders.[4]
• Recognise that a report on the economic costs of cancer for Guam was completed in 2014, without providing a monetary estimate or quantified economic value.[13]
• Operate prevention, screening, survivorship, advocacy and data activities without specified programme costs, allocations, funding sources, resource-mobilisation targets, funding gaps or economic assumptions in the supplied sections.[3][8][10][11]

No monetary amount is reported for the United States Centers for Disease Control and Prevention Cooperative Agreement, the proposed insurance-data analysis, or the action-team activities.[4][12]Consequently, the source does not permit assessment of affordability, cost-effectiveness, resource sufficiency or unfunded requirements.[3][4]