National Cancer Control Plan 2022-2027

Objectives

The Cook Islands National Cancer Control Plan 2022-2027 seeks to prevent, control and manage cancer’s impact by providing quality and equitable cancer health-care services. Its overall aim is to reduce cancer-related morbidity, mortality and disability, contributing to healthier lives across the Cook Islands.[1]The plan treats cancer as a national priority and adopts an integrated continuum spanning prevention, early detection, diagnosis, treatment, palliative care and health-system support.[2]

• Reduce the prevalence of priority cancers by 25%, increase the proportion diagnosed in situ or localised by 25%, and reduce cancer mortality by 25% by 2027.[1]
• Advance six action areas: health promotion, health literacy and community empowerment; early detection; diagnosis; treatment; palliative care; and health-system strengthening.[2]
• Address shared non-communicable disease risk factors, including overweight and obesity, physical inactivity, harmful alcohol use, smoking and unhealthy diets.[2]
• Support the elimination of cervical cancer as a public-health problem by 2030, aligned with the Global Strategy to Accelerate the Elimination of Cervical Cancer as a Public Health Problem.[2]
• Increase early-stage cancer diagnosis, defined for this purpose as Surveillance, Epidemiology, and End Results summary stages 0 and 1, and embed cancer screening within a national health screening unit.[3]
• Expand organised screening for cervical, breast, prostate, skin and colorectal cancers, including a target of 80% cervical screening coverage by 2027.[3][4]
• Develop an evidence base and a 10 to 15-year roadmap for appropriate diagnostic, treatment and palliative-care capacity.[5]
• Provide dignified end-of-life care through reliable pain relief, home-based care, caregiver support and respite-care provision.[5]
• Strengthen cancer information, emergency resilience and multisectoral coordination to improve planning, advocacy, service continuity and accountability.[6][7]

Implementation

Implementation combines prevention and health-promotion measures with organised screening, local service strengthening, overseas referral where needed, palliative care, improved cancer registration and cross-sector governance.[1]The Clinical Governance Committee at Rarotonga Hospital provides the principal national cancer leadership structure, while Te Marae Ora is intended to coordinate delivery through a national health screening unit and a multisectoral cancer control committee.[2][6][7]

• Deliver prevention through healthy-lifestyle education, physical-activity promotion, food labelling, alcohol and tobacco control, sun-smart campaigns, cancer-awareness activities and human papillomavirus vaccination outreach.[8][9]Human papillomavirus vaccination is provided in two doses for girls from age nine, with planned extension to boys, while hepatitis B vaccination is routinely provided at birth.[10]
• Establish a comprehensive national screening unit with dedicated staff, budget, data management, reporting pathways, key performance indicators, supply management, recall systems and partnerships with non-governmental organisations.[4]The unit is expected to oversee cancer screening programmes, collect monitoring and evaluation data and report quarterly to the Permanent Secretary.[6][7]
• Adapt cervical screening guidance to the Cook Islands context, using New Zealand eligibility guidance as an interim basis, and develop implementation guidance, registers, tracking and call-back systems.[11][3][4]
• Strengthen primary-care access to faecal occult blood testing, prostate-specific antigen testing and digital rectal examination, clinical breast examination, breast self-examination education, visual inspection with acetic acid, Pap smears and human papillomavirus testing.[12]Train clinicians to teach breast self-examination and run awareness campaigns that address breast cancer, screening and stigma.[3][12]
• Improve diagnosis through computed tomography guidance, biomedical and engineering training, fast-track clinical and administrative procedures, tele-diagnosis partnerships for pathology and radiology, and stronger referral guidance.[12]Local diagnostic capacity includes computed tomography introduced in late 2020 and ultrasound supporting breast-cancer diagnosis, but cytology and tissue specimens are sent to New Zealand because definitive pathology is unavailable in-country.[11]
• Maintain overseas referral for most patients requiring treatable cancer care, including prompt referral for invasive cervical cancer, while providing basic surgery in Rarotonga such as mastectomy, hysterectomy and lumpectomy.[11][5]Te Marae Ora aims to send diagnosed patients overseas within one month, while the plan also includes a target for treatment initiation or overseas referral within two weeks of diagnosis.[11][7]
• Implement palliative-care standard operating procedures and clinical guidance, train primary healthcare workers in pain management and counselling, support returning patients and families, increase caregiver funding and establish an in-country respite-care facility.[13][5]
• Strengthen safer health-system environments through Public Health Act 2004 amendments, conflict-of-interest registers for non-communicable disease bodies, tobacco-control measures, an alcohol-control action plan and the Cook Islands Dietary Guidelines 2022-2025.[14][15]
• Upgrade the cancer registry through CanReg 5 functionality, clinician training, International Classification of Diseases for Oncology coding, documented procedures, data-quality monitoring and regular reporting.[6]Registry improvement is important because 31% of recorded cases have missing data and overseas diagnosis or treatment information is often not returned.[13]
• Monitor progress through indicators covering awareness, risk factors, vaccination, screening coverage, diagnostic turnaround, early-stage presentation, treatment access, palliative-care capacity, cancer incidence and mortality.[8][9][3][4][12]Named responsible functions include health promotion, policy and planning, community nursing, public health, primary care and hospital health services.[8][9][5]
• Engage the Cook Islands Family Welfare Association and Cook Islands Breast Cancer Foundation in awareness and screening engagement, formalise collaboration with supportive non-governmental organisations, and convene the multisectoral cancer control committee four times annually.[13][6][7]
• Resource delivery through dedicated screening-unit staffing and budget, caregiver-support disbursements and overseas-referral expenditure; however, the supplied material does not specify a total programme budget, financing sources or quantified funding gap.[4][5][11]

Monitoring & Evaluation

The plan establishes a monitoring and accountability approach centred on cancer registration, screening data, service-performance indicators and assigned leadership roles. It aims to improve data completeness, measure progress towards earlier diagnosis and reduced mortality, and use routine reporting to inform planning, advocacy and resource mobilisation.[1][6]

• Strengthen the MedTech-based cancer register and transition or enhance functionality through CanReg 5, clinician training, International Classification of Diseases for Oncology coding, documented procedures, data-quality monitoring and regular reports.[13][6]
• Address substantial registry limitations, including missing data in 31% of cases, absent documentation of information sources, incomplete data following overseas referral and probable under-detection or under-reporting of cervical cancer.[10][13]
• Measure registry quality through the proportion of annual entries with unknown items in the International Agency for Research on Cancer minimum data set, reducing this from a 100% baseline to 20% in 2023 and 5% in 2027.[6]
• Monitor population and programme outcomes through obesity prevalence, cancer knowledge, human papillomavirus vaccination coverage, screening uptake, early presentation, tobacco and alcohol policy measures, skin-cancer incidence, cancer mortality and priority-cancer incidence.[8][9][7]
• Track cervical screening coverage, which was estimated at 54% ever screened among women aged 30 to 49 in 2019, while 35% had received cytology screening within the preceding three years.[11]Human papillomavirus vaccination coverage exceeded 80%, although coverage above 90% is identified as necessary to meet and sustain cervical-cancer elimination targets.[10]
• Monitor organised screening through coverage of eligible populations, screening registers, call-back and follow-up systems, point-of-care treatment after positive tests, availability of screening services and the volumes of cancer tests requested and processed.[3][4][12]
• Measure diagnostic performance through monthly computed tomography requests and completions, the interval from testing to results available to clinicians, adherence to referral and clinical-management guidance, and timely specialist consultation.[12]
• Track treatment and palliative-care performance through completion of the service-capacity analysis and roadmap, overseas treatment for women with invasive cervical cancer, workforce ability to provide pain management and counselling, caregiver disbursements, and use of respite-care places.[5]
• Use targets including 80% cervical screening coverage by 2027, 70% human papillomavirus screening coverage by 2027, 90% treatment coverage for screen-positive tests by 2027, and a five-day testing-to-results turnaround target set for 2023.[3][4][12]
• Review broader outcomes against baselines of 36% localised or in-situ diagnoses in 2018 to 2020, 17% cancer mortality in 2016 and combined priority-cancer incidence of 114.8 per 100,000 in 2018; intended targets include 60% early-stage diagnosis, 13% mortality and a 20% incidence reduction.[7]
• Assign accountability to the Clinical Governance Committee at Rarotonga Hospital and to named managers and directors across policy and planning, health promotion, community nursing, public health, primary care and hospital health services.[2][8][9]
• Establish a national health screening unit within Te Marae Ora to oversee programmes, collect monitoring and evaluation data and report quarterly to the Permanent Secretary.[6][7]
• Support oversight through a multisectoral cancer control committee, four committee meetings annually, formal agreements with non-government partners and four registry reports per year by the end of 2023.[6][7]

Surveillance estimates require cautious interpretation because some diagnoses and treatment occur in New Zealand and information does not consistently return to the Cook Islands; estimated cervical-cancer incidence therefore ranges from 11 to 45 per 100,000 woman-years.[16]The supplied material does not provide a single comprehensive evaluation methodology, although it specifies numerous indicators, responsible officials and selected reporting arrangements.[13][5][14]

Costing & Financing

Financing information is limited and fragmented. The plan identifies cancer control as resource-constrained, particularly because of human-resource, technology and service-capacity limitations, and recognises rising health-system costs associated with non-communicable diseases and population ageing.[2]

• Record Cook Islands Government expenditure of NZ$700,669 for 153 overseas cancer referrals in 2017, equivalent to an average NZ$4,579 per referral.[11]
• Note that the reported overseas-referral cost was considered relatively low compared with most Pacific Island countries because treatment costs were not required.[11]
• Provide a dedicated budget and human resources for the proposed comprehensive cancer screening unit, including responsibility for service resourcing, supplies, data management, monitoring and reporting.[4]
• Include an indicative costing reference of 50k for sustaining cancer control during health emergencies, although the source does not identify the currency or period.[8]
• Increase financial support for caregivers, measured as disbursements per capita per year, with a baseline minimum-wage figure of NZ$17,680 and targets of NZ$18,720 in 2024 and NZ$19,760 in 2027.[5]
• Use partnerships with non-government organisations to share implementation resources, although no monetary value or funding commitment is specified.[6]

The supplied material does not specify a total cancer-control budget, financing structure, funding sources, resource-mobilisation strategy, detailed costed implementation plan, quantified funding gap or wider economic assumptions.[2][11][4][6]