National Comprehensive Cancer Control Program (CCC)

Objectives

The Republic of the Marshall Islands Comprehensive Cancer Control Plan aims to minimise the impact of cancer and improve communities’ quality of life through an integrated framework spanning prevention, early detection and screening, survivorship, and palliative care.[1]The plan identifies 12 approved objectives with associated strategies, addressing cancer risk factors, vaccination, sexual health, screening, survivorship support and end-of-life care.[2][3]

• Reduce obesity by improving diet and physical activity, with targets to reduce adult obesity from 44% to 39% by 30 June 2027 while maintaining youth obesity at 7.3%.[4][5]
• Reduce tobacco use by strengthening tobacco and betel nut policies and warnings, promoting cessation, and reducing adult tobacco use from 38% to 33% and youth current smoking from 17.6% to 13%.[4][5]
• Increase human papillomavirus vaccination through school-based delivery and home visits, aiming to raise completion of the two-dose series among adolescent females aged 13–15 from 45% to 57.5%.[4][5]
• Increase hepatitis B virus vaccination and treatment, including childhood vaccination and targeted adult vaccination for high-risk people; targets seek to increase vaccination among children aged two years from 88% to 90% nationally and from 73% to 80% in outer islands.[4][3][5]
• Increase condom use through awareness and distribution activities, aiming to reduce the proportion of sexually active young people who did not use a condom from 67.5% to 60%.[4][3][5]
• Increase risk-appropriate screening for breast, cervical, colorectal and oropharyngeal cancers by improving access, reducing structural barriers and supporting timely follow-up.[3]Mammography targets are to increase screening among women aged 40–64 from 16% to 21% and among women aged 50–74 from 22% to 25%.[5]Cervical-screening measures aim to increase coverage among women aged 21–65 from 25% to 40%, with a second reported measure increasing from 34% to 40%.[5]Colorectal-screening measures aim to increase screening among adults aged 50–75 from 10% to 17%, with a second reported measure increasing from 23% to 25%.[5]
• Improve cancer survivorship by increasing public knowledge, access to information, survivorship care, treatment summaries and survivorship care plans.[3]Targets aim to increase the average quality-of-life score from 4.56% to 7.06% and increase the proportion of recently diagnosed patients receiving a treatment summary and survivorship care plan from 33% to 50%.[6]
• Strengthen palliative care by improving service availability, case management and healthcare-provider education on end-of-life care.[3]The target is to increase palliative-care receipt among cancer patients in the past two reporting years who received no cancer treatment from 60% to 75%.[6]

Implementation

Implementation combines coalition-led planning with community, patient, provider and health-system interventions.[2][3]The Republic of the Marshall Islands Comprehensive Cancer Control Program led development of the plan, supported by a committee of selected coalition members, and used programme evaluation reports, assessments and data analysis to develop objectives and strategies.[2]The coalition approved the objectives after five planning meetings; the draft was then submitted to Ministry of Health leadership and presented at the Annual Cancer Summit on 16 June 2022.[2]

• Coordinate delivery through Ministry of Health cancer programmes, partner clinics and clinicians, non-communicable disease, reproductive health, immunisation, sexually transmitted disease and HIV programmes, referral services, community organisations, schools, youth organisations, cancer survivor groups, and other public and civil-society institutions.[4]
• Deliver prevention and vaccination through community education, school-based services, home visits for childhood vaccination, targeted adult vaccination for high-risk people, hepatitis B treatment, tobacco cessation support, and condom awareness and distribution.[4][3]
• Improve screening through patient navigation, community education, access-support measures, client reminders, provider assessment and feedback, small-media communications, and evidence-based clinical guidelines.[3]
• Address geographical barriers affecting outer-island communities, which are underserved and may only be reachable by boat, while flight schedules are unreliable.[1][2]
• Strengthen survivorship care by teaching survivors how to access information, educating healthcare providers and decision-makers, disseminating public information, implementing evidence-based care plans, supporting relevant policies, improving clinical-guideline use, and establishing multidisciplinary teams.[3]
• Enhance palliative-care delivery by assessing and improving available services, developing and maintaining case-management programmes, and educating healthcare providers about end-of-life care.[3]
• Use listed measures and data sources to monitor progress, including the Hybrid Survey, Rapid Youth Survey, Office of Health Planning and Policy Services, chart review, five-year averages, and the Cancer Survivor Survey using the City of Hope Quality of Life Scoring Tool.[5][6]

Monitoring & Evaluation

The plan establishes measurable cancer-control targets to be achieved by 30 June 2027, spanning risk factors, vaccination, condom use, cancer screening, survivorship and palliative care. It identifies several data sources for baseline measurement and monitoring, but the supplied material does not specify a reporting timetable, evaluation governance structure, surveillance system or formal accountability process.[5][6]

• Reduce adult obesity from 44% to 39% while maintaining youth obesity at 7.3%.[5]
• Reduce adult tobacco use from 38% to 33% and youth current smoking from 17.6% to 13%.[5]
• Increase completion of the two-dose human papillomavirus vaccination series among adolescent females aged 13–15 years from 45% to 57.5%.[5]
• Increase hepatitis B vaccination coverage among children aged two years from 88% to 90% in the Marshall Islands and from 73% to 80% in outer-island communities.[5]
• Reduce the proportion of sexually active young people who did not use a condom from 67.5% to 60%.[5]
• Increase mammography uptake among women aged 40–64 years from 16% to 21% and among women aged 50–74 years from 22% to 25%.[5]
• Increase cervical screening among women aged 21–65 years from 25% to 40%, with a second reported measure rising from 34% to 40%.[5]
• Increase colorectal screening among adults aged 50–75 years from 10% to 17%, with a second reported measure rising from 23% to 25%.[5]
• Increase the average cancer-survivor quality-of-life score from 4.56% to 7.06% and increase the proportion of recently diagnosed patients receiving both a treatment summary and survivorship care plan from 33% to 50%.[6]
• Increase receipt of palliative care from 60% to 75% among cancer patients in the past two reporting years who received no cancer treatment.[6]
• Use the Hybrid Survey, Rapid Youth Survey, Office of Health Planning and Policy Services, chart review, five-year averages, and the Cancer Survivor Survey using the City of Hope Quality of Life Scoring Tool as reported data sources.[5]

Planning was informed by programme evaluation reports, assessments and data analysis before objectives and strategies were developed for coalition consideration.[2]Although the extract refers to a section titled “Measures and Target”, it does not provide fuller details of indicator definitions, disaggregation, data-collection frequency, responsible reporting bodies, publication arrangements, corrective actions or enforcement mechanisms.[1][5][6]

Costing & Financing

The supplied material contains one general health-expenditure figure but does not provide a costed cancer-plan budget or describe cancer-specific financing. Health expenditure is reported as 643 per capita, without a stated currency, year, funding source or indication of whether the amount relates to public, private or total expenditure.[2]

• Record health expenditure of 643 per capita as a contextual resource figure; the extract does not associate it with a specific cancer-control activity, programme allocation or budget line.[2]
• Specify no cancer-plan budget, activity-level costs, capital costs, recurrent expenditure estimates, funding allocations or implementation costings.[1][2][4][3][5][6]
• Specify no financing sources, donor contributions, domestic-resource mobilisation arrangements, co-financing requirements or funding-gap assessment.[1][2][4][3][5][6]
• Specify no economic assumptions, unit costs, inflation assumptions, affordability analysis, cost-effectiveness assessment or financial-risk analysis.[1][2][4][3][5][6]

Operational constraints may affect resource needs because outer-island communities are underserved, some islands are accessible only by boat, and flight schedules are unreliable; however, the extract does not quantify transport costs, workforce requirements, supply-chain expenditure or the funding required to address these access barriers.[1][2]