2. Rationale
Rationale
• The development of a national cancer control
The development of a national cancer control
plan in Egypt is crucial in response to the
increasing burden of cancer and the high need
increasing burden of cancer and the high need
for coordinated multi‐sectoral action.
• Work on a strategy to control cancer has been
• Work on a strategy to control cancer has been
gathering a momentum for a number of years.
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3. Economic burden of cancer is either
Economic burden of cancer is either
• Direct cost which is most obvious in health
Direct cost which is most obvious in health
care costs, such as those for hospitals, other
health services and drugs
health services, and drugs.
• Indirect costs which arise from loss of
productivity as a result of the illness disability
productivity as a result of the illness, disability
and premature death of those affected.
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4. Global situation
Global situation
• The global cancer burden has doubled in the
The global cancer burden has doubled in the
last thirty years of the twentieth century.
• It is estimated that this will double again
• It is estimated that this will double again
between 2000 and 2020 and nearly triple by
2030
2030.
• Cancer is expected to overtake cardiovascular
di b h l di f d h
diseases to become the leading cause of death
worldwide.
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5. Regional situation
Regional situation
• Cancer incidence is expected to almost double in
p
the next two decades, being 456,000 new cases
in 2010 to nearly 861,000 in 2030, which is the
highest relative increase among all WHO regions
highest relative increase among all WHO regions.
• The above estimates are based only on the effect
of population growth and ageing, but the
additional effect of increasing exposures to
cancer risk factors, such as smoking, unhealthy
diet physical inactivity and environmental
diet, physical inactivity and environmental
pollution, will lead to an even bigger rise in the
burden of cancer.
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6. National situation
National situation
• According to the most recent published results
According to the most recent published results
of National Cancer Registry, cancer cases are
expected to increase from 2013 ‐ 2050 due to
expected to increase from 2013 2050 due to
change in population growth and change in
population structure
population structure.
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8. National situation
National situation
• The estimate of cancer incidence was
The estimate of cancer incidence was
113.1/100,000 of total population in 2012,
and 114 98/100 000 of total population in
and 114.98/100,000 of total population in
2013.
• Projections to 2050 estimate the incidence of
• Projections to 2050 estimate the incidence of
cancer in Egypt to be 341.169/100,000 of total
population
population.
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10. Results of the National Population‐Based
C R i P f E i 2008 2011
Cancer Registry Program of Egypt in 2008–2011
Site % Crude rate ASR
Male
Liver 33.63 39.5 61.8
Bladder 10.71 12.6 21.1
Lung* 5.69 6.7 10.4
Non‐Hodgkin lymphoma 5.48 6.4 8.8
Brain** 5.48 6.4 8.8
Prostate 4.27 5.0 9.3
Breast 32.04 35.8 48.8
Liver 13 54 15 1 24 4
Female
Liver 13.54 15.1 24.4
Brain** 5.18 5.8 8.0
Ovary 4.12 4.6 6.3
Non‐Hodgkin lymphoma 3.80 4.2 6.1
Thyroid 3.28 3.7 4.3
Both
Liver 23.81 27.5 43.6
Breast 15.41 17.8 24.3
Bladder 6 94 8 0 13 5
Sexes
Bladder 6.94 8.0 13.5
Brain** 5.29 6.1 8.5
Non‐Hodgkin lymphoma 4.64 5.4 7.5
Lung* 4.22 4.9 7.5
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11. Prevalence of cancer risk factors
Prevalence of cancer risk factors
Egypt has conducted a national steps survey in
Egypt has conducted a national steps survey in
2012 and the results reported were:
• 24% of Egyptian population are current
• 24% of Egyptian population are current
smokers
72% d i h i l i i
• 72% do not engage in any physical activity
• 95% consume less than 5 servings of fruits and
vegetables / day
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12. Contributing building Blocks of cancer care
Contributing building Blocks of cancer care
According to WHO there are six building blocks required
Governance
According to WHO there are six building blocks required
to build an effective health care system
Governance
Health care financing
Improved health
(level & equity)
Health work force
Medical products, technologies
Responsiveness
Financial risk
Information & reseach
Service delivery
protection
Improved efficiency
Service delivery
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13. Current situation analysis
Current situation analysis
• One of the major challenges is the complexity
One of the major challenges is the complexity
and fragmentation of the health care system
in Egypt with a large number of public entities
in Egypt with a large number of public entities
involved in the management, financing, and
provision of care
provision of care.
• Egypt is rolling out a new insurance scheme,
based on different levels of health care
based on different levels of health care.
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14. Current situation analysis
Current situation analysis
• In Egypt there are many obstacles that face
In Egypt, there are many obstacles that face
the attainment of effective care, better
diagnosis and early detection of cancer
diagnosis and early detection of cancer.
• One of the main obstacles is the inadequate
education of health care providers and the
education of health care providers and the
public as well in addition to the financial
constraints
constraints.
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15. Current situation analysis
Current situation analysis
• The distribution of medical centers delivering cancer
services shows great pattern of inequality being
concentrated in Cairo and the big cities with
concentration of trained medical professionals in the
p
same areas, leaving minimal services delivery in
remote areas and frontiers, where the patient has to
travel for more than 500 Km to reach medical advice
and treatment.
• Currently health authorities are adopting a new
initiative to bring highly qualified medical professionals
initiative to bring highly qualified medical professionals
in all specialties including working in hospitals in
remote areas part of their time for cancer control
activities
activities.
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16. Current situation analysis
Current situation analysis
• A great opportunity in Egypt is having over
A great opportunity in Egypt is having over
5000 PHC centers distributed all over the
country covering rural and urban areas and
country covering rural and urban areas and
can play the key role in the control of chronic
diseases including cancer as a part of
diseases including cancer as a part of
integrated non‐communicable diseases
control policy evolved by WHO
control policy evolved by WHO.
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17. Type and distribution of primary
h l h f l
health care facilities in Egypt, 2012
Urban Rural
PHC
MCH
FH FH
PHC
Type
Total
Health
Office
District
Clinic
Center
(Maternal
&child
Urban
Center
Center
(family
Center
Family
FH Unit
Family
health)
&child
health)
health) health)
health)
Number
of 314 74 156 154 294 392 3,762 5,146
facilities
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18. Action plan
Action plan
• A well‐planned and‐managed national cancer
p g
control program lowers cancer incidence and
improves the life of cancer patients, no matter
what resource constraints the country faces
what resource constraints the country faces.
• All activities taken to meet the purposes of the
cancer control strategies must work within the
framework of the strategic national plan of NCDs,
prevention and control that ensure equitability
among all population sustainability reflect a
among all population, sustainability, reflect a
person–centered approach, and use an evidence
based approach.
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19. The main six components of the
ti l t l l f E t
national cancer control plan of Egypt
• Registry
• Prevention
• Early detection
• Management
• Management
• Palliative care
• Research
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20. Main goals of the national cancer
l l
control plan
• Scaling up the national cancer registry program.
Sca g up t e at o a ca ce eg st y p og a .
• Prevention of exposure to cancer risk factors.
• Implementation of practical early detection
Implementation of practical early detection
programs.
• Improving quality of life and survival of cancer
p g q y
patients through proper and standardized
management.
• Establishment of palliative care program.
• Encourage cancer research of national interest.
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21. Goal (1)
l f
Scaling up of cancer registry
• Objectives
– Consider cancer registration as a part of routine
activity of all cancer centers
– Raising capacity of registry staff to efficiently guide
all registries to achieve data content of high
quality.
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22. Goal (2)
P ti f E t C Ri k
Prevention of Exposure to Cancer Risk
• Among the most important common
Among the most important common
modifiable risk factors underlying cancer and
all other chronic diseases:
all other chronic diseases:
– Tobacco use,
Unhealthy diet with low fruit and vegetable
– Unhealthy diet with low fruit and vegetable
intake,
– Physical inactivity
– Physical inactivity,
– Overweight and obesity
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23. Goal (2)
P ti f E t C Ri k
Prevention of Exposure to Cancer Risk
• Objectives
Objectives
– Periodic assessment of the prevalence of the
underlying cancer risk factors
underlying cancer risk factors
– Reduction of tobacco consumption.
– Promotion of healthy life style regarding weight
– Promotion of healthy life style regarding weight
control, physical activity and healthy diet.
– Reduction of the prevalence of chronic Infection
Reduction of the prevalence of chronic Infection
including (HCV, HBV and, Human Papilloma Virus
and Helicobacter bacteria).
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24. Goal (2)
P ti f E t C Ri k
Prevention of Exposure to Cancer Risk
• Responsibility: MOH and International
Responsibility: MOH and International
Organizations like WHO, UNICEF.
• Outcome: Reliable comparable data on the
Outcome: Reliable comparable data on the
national level enable Egypt to compare its
status with other countries.
• Indicators:
– Number of national surveys conducted /3‐5years.
y / y
– Availability of national published data on the
cancer risk factors
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25. Goal (3)
I l t ti f ti l l d t ti
Implementation of practical early detection programs
• Objectives:
Objectives:
– Establishing clinical guidelines for early diagnosis
of different types of cancer
of different types of cancer
– Raising public awareness
– Investment in health care service
– Investment in health care service
– Establishment of organized screening programs for
high risk group
high risk group
3/6/2017 25
26. Goal (4)
Improve quality of life and survival of cancer patients through proper
p q y p g p p
and standardized management
• Objectives:
Objectives:
– Establish national updated evidence based
guidelines for medical and surgical management
guidelines for medical and surgical management
of cancer
– Ensure access to essential medicines and
Ensure access to essential medicines and
technologies for cancer care
– Strengthen the role of nursing staff and the
g g
paramedical to the standards of efficiency
expected
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27. Goal (5)
bli h f lli i
Establishment of palliative care program
• Objectives:
Objectives:
– Develop a national policy for palliative care.
Ensure that standards for cancer palliative care
– Ensure that standards for cancer palliative care
including pain relief are progressively adopted
nationwide by all levels of care.
nationwide by all levels of care.
– Adopt a palliative care team.
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28. Goal (6)
E h f i l i
Encourage cancer research of national interest
• Objectives:
j
– Ensuring that research discoveries are translated into
advances in prevention, early detection and treatment
for cancer.
for cancer.
– Enhance the existing infrastructure to create a
comprehensive research that can be used to
understand the range of health issues that cancer
understand the range of health issues that cancer
survivors face and any differences between survivor
groups based on demographic and medical variables
Thoroughly understand the factors associated with
– Thoroughly understand the factors associated with
susceptibility to problems during each stage of cancer
survivorship.
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29. National Cancer Control Committee
National Cancer Control Committee
• A national cancer control committee was
formulated by a ministerial decree to set
formulated by a ministerial decree to set
policies, coordinate, supervise and monitor all
activities of cancer control plan
activities of cancer control plan
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30. Role of
l l
National Cancer Control Committee
1. Planning of a National Cancer Control Strategy
2. Supervise and follow up implementation of cancer control action
plan
3. Set policy directions.
d f d l l
4. Advocate for and ensure political commitment.
5. Advise about possible necessary resources.
6. Formulate the technical subcommittees.
7. Coordinate the work of all official partners like the NGOs, other
Ministries.
8. Recommend legislative actions.
9 R d d h
9. Recommend and support cancer research.
10. Suggest health profession educational programs and training
activities.
11 Monitor the information and evaluation systems
11. Monitor the information and evaluation systems.
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