The most recent integrated mission of the IAEA’s Programme of Action for Cancer Therapy, otherwise referred to as an imPACT Review, held in Burkina Faso last month, marks the 100th such Review to be delivered by the IAEA and its partners to help countries increase access to cancer care. imPACT Reviews, conducted jointly by the IAEA and the World Health Organization and the International Agency for Research on Cancer (IARC), examine a country’s readiness to provide cancer services, and provide recommendations which can be used in the formulation of a national cancer control programme.
Burkina Faso’s 2019 imPACT Review, following the country’s first Review in 2010, was requested by the Ministry of Health to help identify priorities and actions to help increase the availability and public access to cancer services.
“With the increase in both cancer cases and deaths, this disease has become a public health priority for Burkina Faso,” said Léonie Claudine Lougue, the country’s Minister of Health. “The way we tackle cancer and cancer control planning needs to be strengthened. Upgrading health professionals’ skills is essential in responding to these challenges, particularly as we are planning to expand radiotherapy services.”
imPACT Reviews: Contributing to cancer control
Over the last 15 years, the IAEA has conducted 100 imPACT Reviews in 91 countries, upon requests received from national authorities, with the goal of supporting the planning and decision-making needed for national cancer control activities.
Each Review draws together a broad range of international cancer control experts, nominated by the IAEA, WHO and IARC. The Reviews contribute to the development of national cancer control plans, assist in the formulation of workforce development plans, and support the mobilization of funds to set up or strengthen cancer services. They also highlight areas where the IAEA, through its technical cooperation programme, can offer interventions to enhance national cancer control systems and contribute to the establishment of safe radiation medicine practices.
“Providing cancer care is more than just buying a radiotherapy machine,” said Lisa Stevens, the Director of the IAEA’s Programme of Action for Cancer Therapy. “Infrastructure needs to be built, specialised staff have to be trained as well as putting in place safety measures and procuring necessary equipment with ongoing maintenance,” she said. “As an imPACT Review is usually the first step a country takes in developing a cancer control strategy, its recommendations need to provide the best evidence and guidance for the Government’s future decisions and planning.”
And health authorities are listening.
In Mongolia, for example, the Ministry of Health implemented recommendations from its 2009 imPACT Review, endorsing the General Action Plan on Cancer Prevention and Control for 2011–2021 and the National Cancer Control Plan 2007–2017. Since 2010, Mongolia has successfully implemented IAEA-supported projects in paediatric cancer care, palliative care and training in radiation medicine.
Following an imPACT Review in 2013, Pakistan’s authorities strengthened cancer control efforts, including the establishment of a cancer registry and the initiation of efforts to increase the number of facilities capable of providing cancer treatment services.
Nicaragua, which received its imPACT Review in 2006, has implemented a nationwide cervical cancer initiative. The project has empowered the Ministry of Health, medical universities and civil society to establish the pioneering national programme.
Why Reviews are needed
According to IARC, 18 million people around the world developed cancer and 9.5 million died from the disease in 2018. By 2030, these annual figures are expected to increase by a third. The greatest impact of this increase will be felt in developing countries, which are expected to suffer around 70 percent of cancer deaths by this time.
Elisabete Weiderpass, IARC’s Director, points out that cancer is either the first or second leading cause of premature deaths in almost 130 countries. This makes the need for accurate and timely monitoring of cancers even more pressing. “Through imPACT Reviews we assess the readiness of countries to collect and analyse local cancer data, which often leads to subsequent collaboration on population-based cancer registries, thus enabling evidence-based decision-making at country level,” she said. “During missions, we sometimes observe a limited awareness of the effectiveness of cancer prevention and early detection measures among national stakeholders in cancer control.”
Cherian Varghese, the WHO’s Coordinator for the Management of Noncommunicable Diseases, notes that access to comprehensive and cost-effective cancer services is a fundamental part of cancer control. “This is a big task for countries,” says Varghese. “The imPACT Review is an important initiative which highlights where progress can be made. The imPACT Review brings experts to cover the entire cancer care continuum from registry to palliative care and offers a reality-based plan to the country. Engagement with all relevant stakeholders adds momentum to the work in countries”.
Bosnia and Herzegovina requested an imPACT Review in 2015 to assess its cancer control capacities and identify areas for improvement. While cancer treatment is widely available, the assessment investigated how cancer services could be further expanded and strengthened. (Photo: M. Andre/IAEA)
Supporting concrete change
imPACT Reviews are designed to lead to concrete improvements in the cancer treatment environment in countries where treatment was previously scarce or unavailable, depending on national requests for IAEA support, and the availability of resources. imPACT Reviews inform the subsequent development of national plans for cancer control, non-communicable disease or the establishment of radiotherapy services.
“The burden of cancer for women is high in Burkina Faso. Patients face increased by stigma, late diagnosis and limited access to medicines, especially in rural areas,” said Sika Bella Kaboré, First Lady of Burkina Faso, and a speaker at next week’s IAEA Scientific Forum on cancer care. “Access to radiotherapy, increased specialist staff training and greater public awareness are crucial in order to respond to their needs and save them from traveling abroad for treatment. Today more actors are actively involved and there is a strong political will in the fight against cancer.”