Comprehensive Cancer Control Plan 2018-2022

Objectives

The Guam Comprehensive Cancer Control Strategic Plan 2018-2022 provides a five-year, evidence-based framework to reduce cancer incidence, mortality and avoidable cancer burden, progressing towards a cancer-free future in which people embrace healthy lifestyles and live in healthy environments.[1][2][3][4]Its mission is to reduce cancer incidence and mortality through collaboration between public and private stakeholders.[3]

• Reduce exposure to cancer risk factors and promote healthy behaviours through individual, family, institutional, societal and policy change.[5][4]
• Improve prevention, screening, early diagnosis and appropriate treatment, with a focus on detecting cancers at the earliest possible stage.[2][6]
• Enhance survivorship, quality of life, palliative care and support for people with cancer and their families.[2][7]
• Mobilise community and political support for cancer prevention and control policies, programmes, data use and research.[3][8][9]
• Prioritise lung, breast, cervical and colorectal cancers for immediate action, while addressing liver and prostate cancers as intermediate priorities.[10][11]

The strategic framework is organised through five action teams: Prevention; Screening, Early Detection and Treatment; Survivorship and Quality of Life; Policy and Advocacy; and Data and Research.[5]These teams combine risk reduction, early recognition and treatment, survivorship and palliative support, policy action, and improved cancer data to achieve measurable and sustainable reductions in Guam's overall cancer burden.[11][9]

• Increase completion of the Human Papillomavirus vaccination series among children aged 9-18 years by 10% by June 2022.[5]
• Increase community knowledge of colorectal and lung cancer prevention strategies by 5% by June 2022.[5][12][6]
• Increase healthcare providers' use of United States Preventive Services Task Force lung cancer screening recommendations to 60% by 2022.[6][13]
• Increase blood stool testing among adults aged 50-75 years from 10.9% to 15%, colonoscopy uptake from 41% to 46%, and sigmoidoscopy uptake from 2.5% to 7%.[6][13]
• Establish survivorship care plans at four cancer treatment centres and ensure that at least 80% of cancer patients have a survivorship care plan by 2022.[7]
• Support policy, systems and environmental changes for priority cancers, increase the community cancer advocate pool by 50%, and increase public awareness of cancer's community impact by 30% from baseline.[8][9]

Implementation

Implementation uses an inclusive, community-driven and community-based participatory model that builds on evaluation of the 2013-2017 plan, aligns with local, national and regional non-communicable disease initiatives, and treats the plan as a living document subject to action-team review and revision over its five-year lifespan.[10][9]Delivery is coordinated through the Guam Comprehensive Cancer Control Coalition, its Steering Committee and subcommittees, which generally meet monthly, in partnership with the Department of Public Health and Social Services Comprehensive Cancer Control Programme.[2][4]

• Engage public and private sectors, health services, schools, professional bodies, universities, cancer organisations, media, political leaders, faith communities, survivors, advocates and community members in planning and delivery.[12][6][9]
• Strengthen the Human Papillomavirus Workgroup, implement a vaccination action plan, develop provider, parent and adolescent toolkits, and deliver outreach and education activities.[5]
• Establish colorectal and lung cancer workgroups, implement prevention action plans, develop provider toolkits and communications campaigns, and support tobacco cessation programmes.[12][6]
• Disseminate screening guidance through professional organisations, assess provider knowledge and practice at baseline, mid-term and completion, distribute colorectal screening resources, and work to extend insurance coverage for sigmoidoscopy and colonoscopy.[13]
• Review, pilot and implement survivorship care plans in treatment clinics, and develop an advance-directive tool or curriculum with community testing, focus groups, social workers and partner organisations.[7]
• Mobilise policy champions and community advocates through advocacy training, political mapping, letters of support and participation in relevant action-team meetings.[8]
• Disseminate cancer survival and economic-cost reports, update Guam Cancer Facts and Figures, establish an online cancer-data inventory, and explore data sharing with private insurers.[9]

Progress is monitored through action-team indicators, targets and status reporting, using sources including the Behavioral Risk Factor Surveillance System, Youth Risk Behavior Surveillance System, Guam Cancer Registry-related data, action-team reports, Guam Cancer Care and policy reports.[11][14][4]Monitoring includes vaccination completion, screening uptake, provider guideline use, outreach activity, clinic adoption of survivorship plans, policy activity, advocacy participation, report dissemination and data-sharing arrangements.[5][12][13][7][8][9]

The plan identifies important data comparability limitations because indicators revised in the 2016 Behavioral Risk Factor Surveillance System may not be directly comparable with 2013-2017 baseline or subsequent survey data.[15]It does not specify a consolidated reporting timetable, a single evaluation methodology, or an overarching accountability framework beyond the action-team progress indicators, reviews and iterative revisions.[11][14][16][9]

Monitoring & Evaluation

The plan establishes a five-year monitoring approach led by five Action Teams covering prevention; screening, early detection and treatment; survivorship and quality of life; policy and advocacy; and data and research.[5]Progress is intended to be reviewed iteratively, with Action Teams using successes and failures to revise activities throughout the plan period.[9]

• Track prevention indicators including completion of the Human Papillomavirus vaccination schedule, school champions, professional education, colorectal and lung cancer awareness, tobacco-cessation participation, and implementation of outreach, communications and workgroup action plans.[5][12][6]
• Monitor screening outcomes, including provider adherence to United States Preventive Services Task Force recommendations, blood stool testing, colonoscopy and sigmoidoscopy uptake, insurance coverage, toolkit dissemination, and baseline, mid-term and post-assessments.[13]
• Assess survivorship through care-plan template development and revision, clinic adoption, outreach activity, professional and public knowledge, and the proportion of cancer patients receiving a survivorship care plan, targeted at at least 80% by 2022.[7]
• Measure policy and advocacy activity through Action Team representation, adopted policies, advocate training, political engagement, public awareness, and annual growth in Policy and Advocacy Action Team membership.[8][9]
• Monitor data and research outputs through cancer survival and economic-cost reports, cancer facts and figures updates, policymaker briefings, an online data inventory, common data standards, assistance requests, and potential data-sharing arrangements with insurers.[15][9]
• Use named data sources including the Behavioral Risk Factor Surveillance System, Youth Risk Behavior Surveillance System, Guam Cancer Care, Action Team reports, and the Guam Cancer Registry.[11][14][4]

Earlier targets included increasing mammography from 64.4% to 69.4%, Pap testing from 63.5% to 68.5%, colonoscopy or sigmoidoscopy from 42.6% to 47.6%, and blood stool testing from 7.7% to 12.7% by June 2017.[11][14]Provider use of screening guidelines reached 100% in 2015 against a 60% target, while several screening, policy and survivorship actions remained ongoing.[16]Indicator changes in the 2016 Behavioral Risk Factor Surveillance System may limit comparability with the 2013–2017 baseline and later surveys.[15]

The plan provides indicators and Action Team status reporting but does not specify a consolidated reporting timetable, a detailed evaluation methodology, or a formal accountability framework.[11][14][16]

Costing & Financing

Financial information is limited. The plan does not specify programme budgets, activity costs, financing mechanisms, allocations, quantified resource-mobilisation targets, funding gaps, or economic assumptions.[8][9]

• Recognise available resources as one consideration when selecting cancer priorities alongside disease burden, community readiness, political support, health-system capacity and available interventions.[10]
• Use economic evidence by disseminating a completed report on the economic costs of cancer in Guam and exploring a further cost-of-cancer report based on private-insurance data.[15][9]
• Support the publication through Cooperative Agreement Number 6 NU58DP006269-01-01 from the United States Centers for Disease Control and Prevention, without a stated monetary value or allocation.[4]

No quantified cost or financial estimate is provided for the economic-cost report, and no currency, expenditure or funding-gap figure is available in the supplied material.[15][4]