Federated States of Micronesia Comprehensive Cancer Control Plan 2019 – 2024

Objectives

The Federated States of Micronesia Comprehensive Cancer Control Plan 2019–2024 provides one coordinated national and state framework to reduce the cancer burden, raise the standard of cancer care and work towards a cancer-free nation.[1][2][3]It spans prevention, early detection and screening, treatment, palliative care, survivorship and quality of life, using measurable objectives and evidence-based strategies.[1][3][4]

• Prevent cancer by increasing completion of the two-dose human papillomavirus vaccination series among girls aged 11 to 12 years from 63% nationally to 79%, and by increasing hepatitis B immunisation among children.[5][6][7]
• Reduce modifiable risks by lowering overweight and obesity among 13-to-19-year-olds from 37% nationally to 24%, reducing tobacco use and excessive alcohol consumption among adults and young people by 5% by 2024, and reducing youth betel nut use by 5% by 2024.[5][8][6][7]
• Detect cancer earlier by increasing cervical screening, reducing invasive cervical cancer incidence by 10% by 2024, increasing clinical breast examinations, assessing colorectal cancer screening and establishing national colorectal screening, diagnosis and treatment guidance by 2024.[7][9][10]
• Improve treatment capacity by providing quality on-island care, particularly for stage 1 and stage 2 breast and cervical cancers, training providers, equipping facilities and maintaining diagnostic and treatment supplies.[10][4]
• Strengthen palliative care and survivorship by expanding pain management, essential medicines, provider training and coordinated physical, mental, spiritual and practical support for patients, survivors, families and carers.[4][11]

The priorities respond to a substantial cancer burden: lung, oral, cervical and breast cancers are the most commonly diagnosed cancers, national five-year survival is 33%, and late-stage diagnosis is common.[2]Tobacco-related cancers account for 63% of adult cancers, obesity-related cancers for 20%, and 29% of cancers have an evidence-based screening test.[12]

Implementation

Implementation relies on coordinated national and state action led by the Federated States of Micronesia Department of Health and Social Affairs, the FSM National Cancer Coalition, and cancer coalitions in Chuuk, Kosrae, Pohnpei and Yap.[1][2][3]The combined national and state plan is intended to reduce duplication, guide resource decisions, coordinate partners and support adjustment of cancer-control activities based on progress.[13][3]

• Coordinate cancer, non-communicable disease, immunisation, maternal and child health, behavioural health, nutrition, physical activity, tobacco, wellness, dispensary and school programmes with state governments, community organisations and regional partners.[3][5][8][6][7]
• Deliver prevention through school and health-service vaccination, school attendance requirements, community campaigns, workplace wellness, physical education, healthy-food policies, tobacco cessation and controls on tobacco and betel nut.[5][8][7]
• Expand access for remote communities through outreach, screening days, routine hospital and dispensary screening, one-to-one education, patient navigation, provider assessment and feedback.[3][9][10]
• Implement cervical screening using visual inspection with acetic acid, screen women aged 25 to 45 at least twice in their lifetime, refer women with pre-cancerous cells for Pap testing until cryotherapy is available, and provide opportunistic Pap testing where resources permit.[3][9]
• Develop workforce and service capacity through national breast and cervical cancer standards training, telehealth, training-needs assessments, study tours, off-island diagnostic training, partner-supported equipment and quality assurance systems.[4]
• Integrate survivorship into homebound non-communicable disease care, train providers and community carers using palliative-care modules, and advocate for World Health Organization essential medicines and insurance coverage or discounts for pain medicines.[4][11]

Monitoring uses cancer registries in all four states and nationally, linked to the Pacific Regional Central Cancer Registry, alongside immunisation coverage, screening coverage, risk-factor prevalence, cancer incidence, stage at diagnosis, survival, provider training, facility readiness and support services.[3][5][9][10][4][11]Data sources include national immunisation data, youth and population surveys, state cancer programmes, non-communicable disease clinics and registry data; Chuuk cancer data are incomplete.[2][12][5][8]The plan calls for a hybrid survey every two years to improve obesity measurement and tobacco monitoring.[5][8]

Partners are expected to share data, identify common goals, address gaps, coordinate activities and leverage existing policies, programmes and resources.[13]Businesses, churches, elected officials, survivors, families, health-care providers and community members are invited to contribute through education, advocacy, practical support, volunteering and implementation.[11][14]The available text does not specify a consolidated governance workplan, reporting timetable, formal accountability framework, overall budget, funding gap or financing allocations.[13][10][4][11]

Monitoring & Evaluation

The plan establishes a broad performance framework across prevention, screening, treatment, palliative care and survivorship, using measurable national and state objectives, baselines and 2024 targets to guide progress, resource decisions and adjustments.[1][13]Monitoring draws on cancer registries, programme data, surveys and health-service reporting, but no consolidated reporting timetable, evaluation methodology or formal accountability framework is specified.[3][15][11]

• Maintain national and four state cancer registries linked to the Pacific Regional Central Cancer Registry, and use incidence, stage at diagnosis and five-year survival data to assess cancer outcomes.[2][12][3]
• Track vaccination completion, hepatitis B immunisation, overweight and obesity, tobacco use, alcohol consumption and youth betel nut chewing through national and state baselines and targets.[5][8][6][7]
• Use national immunisation data, the National Outcomes Measures Survey, Youth Surveys, Rapid High School Surveys, STEP Surveys, the Kosrae non-communicable disease dashboard and state data sources; establish a hybrid survey every two years for obesity data and improve tobacco monitoring systems.[5][8][6]
• Measure cervical screening among women aged 15 to 44 without hysterectomy who were screened within the previous three years, increasing the national rate from 22% to 32% by 2024; target a 10% reduction in invasive cervical cancer incidence by 2024.[9]
• Monitor clinical breast examinations, with a national target of increasing the number of women examined from 733 to 933 by 2024.[9]
• Complete national and state colorectal cancer screening, incidence and mortality assessments, and establish a national screening, diagnosis and treatment guideline or standard by 2024.[10]
• Track oral cancer incidence, provider cancer-treatment training, equipped treatment facilities, pain and palliative-care policies, provider awareness or training, and availability of pain medicines and palliative services.[10][4]
• Measure survivorship support through the number of social or emotional support services offered, and maintain the five-year survival rate for all cancers by 2024.[11]

Costing & Financing

No overall cancer-control budget, quantified financing plan, funding gap, resource-mobilisation target or economic model is specified.[2][12][10][4]The plan nevertheless frames resource decisions as part of implementation and emphasises coordination and leverage of partner contributions.[1][13]

• Secure diagnostic equipment through partners, maintain quality assurance for supplies and equipment, explore sponsorship for off-island diagnostic training, and seek insurance coverage or discounts for pain medicines.[4]
• Support access to essential medicines and pain medication through advocacy for the World Health Organization essential medicines list, insurance coverage and medicine discounts; no monetary commitment is provided.[11]
• Identify the Strategic Prevention Framework Partnership for Success State Incentive Grant programme as a delivery support mechanism, without specifying its value, source or allocation.[7]
• Use Yap’s Go Local programme to provide medical referral patients with monthly food coupons valued at 40 dollars and inject about 50,000 dollars annually into the local economy during each of the previous two years.[15]
• Recognise potential non-financial support from businesses, elected officials, churches, health programmes, the University of Hawai'i and regional partners, without quantified commitments.[11][14]