National Comprehensive Cancer Control Program (CCC)

Objectives

The strategic mission is to minimise the impact of cancer and improve the quality of life of communities in the Marshall Islands.[1][2]Cancer is the country’s third leading cause of death, with an average of 33.4 cancer-related deaths and 60.4 new cases annually.[1]The plan addresses the cancer continuum through 12 approved objectives spanning primary prevention, screening and early detection, and survivorship.[3]

• Reduce obesity by decreasing sugar-sweetened beverage consumption; increasing healthy food consumption, local food production and awareness of healthy lifestyles; improving infrastructure and access for physical activity; and increasing physical activity among children, young people and adults.[4]
• Reduce tobacco use and betel nut-related risks by strengthening relevant policies and legislation, increasing warnings about tobacco harms, and promoting tobacco cessation.[4]
• Increase vaccination against Human Papilloma Virus and Hepatitis B Virus through school-based, home-visit and adult vaccination programmes, alongside Hepatitis B Virus treatment.[4]
• Increase condom use and distribution among young people as a primary prevention measure.[4]
• Increase risk-appropriate screening for breast, cervical, colorectal and oropharyngeal cancers.[4][2]
• Improve survivorship outcomes by increasing public knowledge, strengthening survivorship care and care-plan use, and improving palliative care services.[2]

The framework recognises that people in outer-island communities may face reduced access to health services and unreliable air or boat transport, making equitable access to prevention, screening, treatment support and survivorship care a material strategic concern.[1]

Implementation

Implementation combines population prevention, organised vaccination, cancer screening support and survivorship care through health services, schools, communities and partner organisations.[3][4][2]Planning was led by the Ministry of Health Comprehensive Cancer Control Program through a committee of selected Marshall Islands Cancer Coalition members, programme assessments, evaluation reviews, data analysis and five coalition planning meetings.[3]The draft was submitted to Ministry of Health leadership and formally presented at the Annual Cancer Summit on 16 June 2022.[3]

• Apply obesity and tobacco-control strategies adopted from the Republic of the Marshall Islands Non-Communicable Disease Plan 2019–2024.[4]
• Deliver vaccination through schools and school-entry requirements, home visits for people outside school or with limited access, and adult programmes.[4]
• Provide community education and public-awareness activities on healthy lifestyles, tobacco harms, vaccination, cancer prevention and survivorship.[4][2]
• Strengthen screening uptake through patient navigation, action to reduce structural barriers, education, provider assessment and feedback, client reminders, small-media communications and evidence-based clinical guidelines.[4][2]
• Develop survivorship support through information access, education for survivors, providers and decision-makers, navigation or case management, evidence-based care plans, supportive policies, multidisciplinary teams and clinical-guideline use.[2]
• Enhance palliative and end-of-life care as part of survivorship service delivery.[2]

Delivery is intended to involve Ministry of Health cancer programmes, partner clinics and clinicians, other health programmes, community organisations, cancer survivors, schools, civil-society organisations and relevant government bodies.[3]The available material does not specify a detailed governance structure, named accountable leads for individual objectives, stakeholder responsibilities, operational timetable or formal coordination arrangements.[1][3]

Planning drew on programme evaluation reports, assessments and analysed data to develop objectives and strategies.[3]Although the plan identifies measures and targets for prevention, screening and early detection, and survivorship, the supplied material does not provide indicators, baselines, numerical targets, reporting procedures, surveillance arrangements, evaluation timetable or accountability mechanisms.[1][2]The supplied material also does not specify a budget, programme costings, funding sources, resource-mobilisation measures, funding gaps or economic assumptions.[1]

Monitoring & Evaluation

Monitoring and evaluation informed development of the cancer control plan through programme assessments, evaluation reports and data analysis, while the plan includes a “Measures and Targets” section covering prevention, screening and early detection, and survivorship.[3][2]

• Use programme evaluation reports, assessments and analysed data to inform objectives and strategies.[3]
• Cover measures and targets across primary prevention, screening and early detection, and survivorship.[2]
• Specify indicators, baselines, numerical targets, reporting arrangements, surveillance procedures, evaluation methods, timelines and accountability mechanisms, which are not detailed in the supplied text.[1][2]

Costing & Financing

The supplied text does not provide a costed implementation plan or describe financing arrangements for cancer control activities.[1]

• Specify programme budgets, activity costs and resource allocations, which are not provided.[1]
• Identify funding sources, resource-mobilisation mechanisms and funding gaps, which are not detailed.[1]
• Set out economic assumptions or financial scenarios, which are not specified.[1]