National Cancer Control Plan

Objectives

Cambodia’s National Cancer Control Plan 2025–2030 provides a comprehensive, coordinated and realistic framework for reducing preventable cancer incidence, morbidity and premature mortality, while improving survival, survivorship and quality of life for people affected by cancer and their families.[1][2][3]Its vision is a low cancer burden, high survival rates and dignified, good-quality lives for patients and families.[1][2][3]The plan supports universal health coverage through equitable, evidence-based and person-centred cancer services.[4][5][3]

• Reduce exposure to modifiable risk factors and social, environmental, occupational and infectious determinants of cancer, including tobacco, harmful alcohol use, unhealthy diets, physical inactivity, overweight, obesity, hepatitis B, hepatitis C and human papillomavirus.[3][6]
• Achieve a minimum 30% reduction in tobacco use among people aged 18–69 years and a minimum 20% reduction in harmful alcohol use by 2030.[3][6]
• Increase cervical cancer screening coverage among women aged 30–49 years to 70% by 2030, with screening linked to timely diagnosis and treatment.[6][7]
• Improve early detection of breast, colorectal, childhood and older-age cancers through awareness, risk assessment, evidence-based screening, recognition of warning signs and prompt referral.[7][8][9][10][11]
• Ensure sustainable and equitable access to timely, accurate diagnosis, quality treatment and care across pathology, laboratory medicine, imaging, nuclear medicine, surgery, medical oncology, radiotherapy and specialised paediatric services.[8][12][13][14][15]
• Expand palliative care, rehabilitation and survivorship support, including pain relief, essential opioids, psychosocial support, physiotherapy, home-based care and social reintegration.[16][17]
• Strengthen the cancer workforce, cancer registration, surveillance, research, digital health, governance, coordination, financing and emergency preparedness.[18][19]

Implementation

Implementation uses a comprehensive, evidence-based, participatory and multisectoral approach across the cancer-control continuum, engaging government, public and private health services, academia, civil society, development partners, communities and people affected by cancer.[1][20][5]The Ministry of Health leads implementation under oversight of the Inter-Ministerial Committee for Non-Communicable Disease Control, while the National Programme for Cancer Control coordinates delivery and mobilises support from relevant ministries, institutions and health partners.[21][22][23]

• Deliver prevention, screening and referral through health centres; provide basic and intermediate diagnostic investigation, essential treatment and surgery through district and provincial referral hospitals; and provide specialised diagnosis, oncology, radiotherapy, chemotherapy and palliative care through national hospitals and designated cancer centres.[24]
• Establish a National Cancer Technical Working Group, professional networks and task forces for cancer imaging, pathology, oncology, palliative care, childhood cancer and cancer registration, with defined terms of reference to support technical coordination and implementation monitoring.[12][13][16][25][23]
• Develop at least one Comprehensive Cancer Centre meeting national standards for diagnosis, treatment, care, education and research by 2030, following a situation analysis, needs assessment and costed implementation plan for Ministry of Health review and approval.[12][26]
• Strengthen referral, diversion and transfer pathways between health centres, referral hospitals, national hospitals and cancer centres, including formal pathways for paediatric oncology and timely access to specialised treatment.[27][7][17]
• Develop national guidelines, protocols, manuals and standard operating procedures for screening, diagnostic work-up, pathology specimen handling, treatment, multidisciplinary care, palliative care and childhood cancer services.[7][12][17][28]
• Expand workforce capacity through national workforce planning, recruitment, specialist curricula, oncology nursing, radiation technology, medical physics, pathology, laboratory and palliative-care training, in collaboration with the University of Health Sciences and international partners.[18][29][30]
• Strengthen medicines and supply systems by developing lists of essential cancer medicines, commodities and services, integrating procurement into national systems, and advocating gradual inclusion in Health Equity Fund and National Social Security Fund benefit packages.[13][25][31]
• Develop population-based and hospital-based cancer registration, beginning with Phnom Penh and expanding progressively, with standardised coding, data collection, electronic records, data-quality audits and childhood cancer registration.[18][22][32]
• Monitor implementation through the implementation matrix in Annex 1 and the monitoring and evaluation indicator framework in Annex 2, covering inputs, activities, outputs, outcomes, progress and challenges.[25][21][31]Conduct routine monitoring and annual progress reviews, with baseline, mid-term and final evaluations scheduled for 2025, 2027 and 2030.[33][32]
• Track cancer incidence, mortality, five-year survival, risk factors, screening, referrals, diagnosis, treatment, service availability, financial protection and inequities through facility data, health management information systems, surveys, civil registration, cancer registries and Global Cancer Observatory estimates.[31][34][35][36][37][38]
• Translate strategic actions into annual operational plans and budgets supported by a three-year rolling budget plan.[21]Conduct baseline and costing studies in 2025 because a total implementation budget was not yet available.[21]Mobilise resources from government, national and international partners, private donations, potential earmarked tobacco and alcohol excise-tax revenue, and a possible Cambodia Cancer Foundation.[25][21][39][31]Existing cancer-prevention activities were estimated at approximately US dollars 7,764,346, and new core activities excluding ongoing prevention at approximately US dollars 500,000 for 2025.[21]
• Prepare cancer facilities for emergencies by maintaining essential chemotherapy, radiotherapy, surgical services and medicines, using telehealth and digital communication, and educating patients, families and caregivers about emergency planning.[21][31]

Monitoring & Evaluation

The National Cancer Control Plan establishes a monitoring and evaluation architecture centred on routine implementation tracking, annual indicator review, cancer registration, data-quality improvement and formal evaluations in 2025, 2027 and 2030. The National Programme for Cancer Control leads monitoring and evaluation under oversight from the Inter-Ministerial Committee for Non-Communicable Disease Control.[21][33]

• Monitor inputs, activities, outputs, outcomes, implementation progress and challenges through the implementation matrix in Annex 1 and the monitoring and evaluation indicator framework in Annex 2.[25]
• Conduct routine monitoring of strategic actions and annual reviews against the Annex 2 indicator framework.[21][33]
• Complete a baseline study in 2025, a mid-term review in 2027 and a final evaluation in 2030, disseminating findings to stakeholders and using baseline results to update data and adjust proposed 2030 targets where needed.[33][32]
• Track impact indicators including crude and age-standardised cancer incidence and mortality rates per 100,000 population, five-year survival by cancer type and stage at diagnosis, and population risk factors such as tobacco use, heavy episodic alcohol consumption, insufficient physical activity and unhealthy diets.[31][34]
• Use Global Cancer Observatory estimates, civil registration and vital statistics, verbal-autopsy surveys, population-based and facility-based cancer registries, routine facility data and surveys including the 2023 STEPS survey.[31][34]
• Monitor service indicators including vaccination coverage, hepatitis C detection and treatment, screening and treatment of cervical precancerous lesions, cancer stage at diagnosis, diagnostic and treatment intervals, availability of diagnostic technologies and specialist staff, multidisciplinary care, palliative care, rehabilitation and essential medicines.[35][36][40][37]
• Strengthen population-based and hospital-based cancer registration through standardised definitions, coding, data sources, collection forms, electronic records, childhood cancer registration and data-quality arrangements.[18][22]
• Begin population-based registration in Phnom Penh, progressively expand registration coverage, reinforce hospital-based registries, conduct data-quality audits and publish national cancer surveillance reports.[41][32]
• Strengthen the Working Group for Cancer Registration to oversee registry development, and use national cancer technical working groups, professional networks and task forces to coordinate and monitor implementation in specific service areas.[18][26][23]

Surveillance capacity remains incomplete: data collection at two principal national cancer-treatment hospitals had continued to 2024, but information needed to estimate incidence, mortality and survivorship was lacking.[41]The Plan therefore prioritises more reliable registry-based surveillance rather than estimates derived from neighbouring countries.[41]

The Plan specifies broad accountability through Ministry of Health leadership, Inter-Ministerial Committee oversight and National Programme for Cancer Control coordination, but the provided text does not detail all reporting responsibilities, public reporting procedures or sanctions for non-performance.[21][23]

Costing & Financing

Financing is framed as essential to implementation, financial protection and equitable access, but the total six-year National Cancer Control Plan budget is not yet available because baseline data, detailed activities and planning time were insufficient.[21]The Plan calls for a 2025 costing study and baseline-data study to establish resource requirements by strategy and strategic action.[21][39]

• Translate strategic actions into annual operational plans and budgets, supported by a three-year rolling budget plan led by the National Programme for Cancer Control.[21]
• Secure 2025 funding for National Programme for Cancer Control operating costs, baseline work, kick-off activities and the costing study.[25][39]
• Mobilise resources from the Royal Government of Cambodia, development partners, international organisations, private donations, foundations and potential public-private partnerships.[21][31]
• Advocate increased government financing and consider earmarking revenue from tobacco and alcohol excise taxes, including for cancer prevention within wider non-communicable disease financing.[25][39]
• Explore establishment of a Cambodia Cancer Foundation and expand reimbursement for essential cancer medicines, commodities and services through the Health Equity Fund and National Social Security Fund.[31]
• Develop costed implementation plans for Comprehensive Cancer Centres and a five-year national strategy for hospital-based and population-based cancer registration.[12][18][26]

Existing cancer-prevention activities are estimated at approximately USD 7,764,346, while new core activities excluding ongoing prevention are estimated at approximately USD 500,000 for 2025.[21]Because the 2025 government budget had already been decided, the first-year new core activities were expected to seek support from national and international health partners.[21]

Cambodia’s mixed health-financing system includes government tax financing, out-of-pocket payments, insurance premiums and external development assistance.[42]Social health protection reaches about 43% of the population, while out-of-pocket payments represented about 55% of current health expenditure in 2021.[42]High out-of-pocket expenditure contributes to delayed care, financial catastrophe and impoverishment among people seeking cancer care.[42]

The economic burden is substantial: premature cancer deaths in Cambodia were estimated to cost US dollars 1.1 billion in 2019, in addition to direct costs.[43]An international investment case estimates that scaling essential cancer services to 90% coverage by 2030 would require US dollars 140 billion, save 7.3 million lives and generate US dollars 325 billion in direct productivity gains plus US dollars 990 billion from averting preventable cancer mortality.[44]These estimates are not presented as a Cambodia-specific National Cancer Control Plan budget.[44]