Federated States of Micronesia Comprehensive Cancer Control Plan 2019 – 2024

Objectives

The Federated States of Micronesia Comprehensive Cancer Control Plan for 2019–2024 provides a coordinated national and state framework to reduce the cancer burden, improve health status and raise the standard of cancer care across the country.[1][2][3]It spans prevention, early detection and screening, treatment, quality of life and survivorship, using measurable objectives and evidence-based strategies to support sustainable change.[4][3]The plan responds to a high burden of lung, oral, cervical and breast cancers, low national five-year survival of 33%, and frequent late-stage diagnosis.[5][6]

• Prevent cancer by increasing completion of the two-dose human papillomavirus vaccination series among girls aged 11–12 years from a national baseline of 63% to 79%, with state-specific targets.[7]
• Reduce modifiable risk factors by lowering overweight and obesity among high-school-aged people from 37.0% to 24%, reducing adult tobacco use, excessive alcohol consumption and youth betel-nut use by 5% by 2024, and strengthening tobacco cessation.[7][8][9]
• Increase early detection by raising cervical screening rates to 32% nationally by 2024, reducing cervical cancer incidence by 10%, expanding clinical breast examinations, and establishing a colorectal cancer screening, diagnosis and treatment standard.[10]
• Improve oral-cancer outcomes by reducing stage 2 oral-cancer cases by 2024, with targets of 25 cases in Yap, 23 in Pohnpei, 1 in Kosrae and none in Chuuk.[11]
• Ensure access to quality treatment, including national clinical guidance for colorectal cancer and strengthened diagnosis, equipment, supplies and quality assurance.[11]
• Enhance quality of life for patients, survivors and families by improving pain and palliative care, social and emotional support, community care and survivorship services.[11][12]
• Strengthen supportive policy and partnership environments by educating decision-makers, coordinating with tobacco-control and immunisation initiatives, addressing health disparities and avoiding duplication of existing programmes.[3][5]

Implementation

Implementation relies on a nationally coordinated, state-led comprehensive cancer-control model involving the Federated States of Micronesia Department of Health and Social Affairs, national and four state cancer programmes and coalitions, state governments and health services in Chuuk, Kosrae, Pohnpei and Yap, and regional, community and political partners.[1][4][13]The plan guides programme activity, resource decisions, progress measurement and adjustment, building on the earlier 2013–2018 coordinated plan and existing health-sector policies and services.[5][13]

• Coordinate action among cancer, immunisation, sexually transmitted disease, tobacco, behavioural health, nutrition, physical-activity, non-communicable disease, maternal and child health and education programmes.[14][7][8][9]
• Deliver prevention through school attendance requirements and school-based vaccination, health-system interventions, physical-activity campaigns, workplace wellness, healthy-food initiatives, food-policy enforcement and tobacco- and betel-nut-control measures.[7][8]
• Increase screening demand and access through individual education, patient navigation, provider assessment and feedback, routine clinical screening, dedicated clinic days, community-based services and outreach to remote communities.[10][15]
• Use visual inspection with acetic acid as the primary cervical-cancer screening method across all four states, supported by trained providers; apply national breast and cervical cancer standards to guide prevention, early detection, palliative care and survivorship training.[14]
• Develop treatment capacity through clinical guidelines, dental screening checklists, oral-cancer risk-factor policies, improved diagnostic equipment and supplies, formal quality assurance, telehealth training, off-island attachments and workforce needs assessments.[11]
• Integrate survivorship support into non-communicable disease homebound care and train carers, families, community groups and providers with support from the University of Hawaii and regional partners.[12]
• Engage municipalities, schools, community health centres, women’s groups, churches, businesses, elected officials, survivors and families in education, advocacy, prevention, screening and support activities.[9][12][16]
• Maintain cancer registries in all four states and nationally, linked to the Pacific Regional Central Cancer Registry, and use registry, hospital, programme, clinic and survey data to identify baselines, targets, gaps and shared priorities.[14][11][12]
• Track progress through vaccination completion, risk-factor surveys, screening coverage, cancer incidence, stage at diagnosis, treatment and palliative-care availability, support-service provision and five-year survival.[7][8][9][10][11][12]

Monitoring & Evaluation

The plan combines measurable prevention, screening, treatment and survivorship objectives with cancer-registry data, programme records, surveys and service-delivery information. It requires progress to be tracked, measured and communicated so that implementation can be assessed and adjusted.[3][5]

• Use national and four state cancer registries linked to the Pacific Regional Central Cancer Registry to support cancer surveillance.[14]
• Monitor the cancer burden through incidence, five-year survival and stage-at-diagnosis measures; the registry data cited cover 2007–2015, although Chuuk data are incomplete.[6]
• Measure human papillomavirus vaccination through completion of the two-dose series among females aged 11–12 years, using 2017 National Immunization Program data.[7]
• Measure overweight and obesity among people aged 13–19 years through rapid high-school surveys and the Yap Youth Survey, and conduct a hybrid survey every two years to collect obesity data.[7]
• Monitor adult tobacco use through the 2012 National Outcomes Measures Survey and youth smoking through youth and rapid high-school surveys; strengthen tobacco-control data-collection and monitoring systems.[8]
• Measure excessive alcohol consumption using national and state STEP surveys, the Kosrae non-communicable disease dashboard, and youth or rapid high-school surveys.[8]
• Track youth betel-nut use as the proportion reporting chewing in the previous 30 days; the national baseline is 47%, with state baselines ranging from 39% in Chuuk to 75% in Yap.[9]
• Measure cervical screening as the proportion of eligible women aged 15–44 screened within the preceding three years, excluding women who have had a hysterectomy. Baselines range from 17% in Pohnpei to 52% in Kosrae, against a national baseline of 22%.[9]
• Track cervical cancer incidence using Pacific Regional Central Cancer Registry data for 2007–2015, and measure breast screening through the number of women receiving clinical breast examinations recorded in national and state health databases and programme records.[9][10]
• Complete colorectal-cancer baseline assessments and analyse screening, incidence and mortality data; the plan records no current assessment, analysis or national colorectal screening standard or guideline.[10]
• Monitor treatment and survivorship through oral-cancer incidence, colorectal screening and mortality data, pain and palliative-care policies and service availability, provider training, social and emotional support services, and five-year survival rates.[11][12]
• Use state hospital reports, state cancer programmes, non-communicable disease clinics and the United States Affiliated Pacific Islands Regional Cancer Registry as identified data sources.[11][12]
• Track reported service gains, including cervical-screening coverage increasing from 9% in 2017 to 16% in 2018 and human papillomavirus vaccination coverage increasing from 45% to 78% in 2017.[14]
• Measure local implementation through campaign, survey and dispensary data, including a Kosrae visual inspection with acetic acid campaign that screened 182 women aged 21–65 through 12 trained screeners.[15]

The covered material does not set out a consolidated indicator framework, regular reporting timetable, evaluation design or formal accountability structure beyond the specified objectives, registries, surveys, programme data, enforcement activity and identified data sources.[14][15][11][12]

Costing & Financing

The covered material provides no consolidated cancer-control budget, costed implementation plan, financing allocation, quantified funding gap, resource-mobilisation target or economic assumption. It nevertheless identifies shared resources and indicates that the plan should inform resource decisions.[3][5]

• Recognise continuing support for capacity and infrastructure from the Centers for Disease Control and Prevention and other regional and national partners, without specifying funding amounts or terms.[1][2]
• Provide monthly Go Local coupons valued at 40 dollars to medical-referral patients from outer islands for local food, fruit, vegetables and fish.[7]
• Record an approximate annual injection of 50,000 dollars into the local economy through the Go Local programme during the preceding two years.[7]
• Note that other prevention, screening, treatment, palliative-care, workforce-development and survivorship actions have no stated programme costs, financing sources, allocations or funding gaps in the covered extracts.[9][10][11][12]