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An analysis of survivorship care strategies in national cancer control plans in Africa

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Abstract

Purpose

In 2017, the World Health Organization urged member states to develop and implement national cancer control plans (NCCPs) and to anticipate and promote cancer survivor follow-up care, which is a critical yet often overlooked component of NCCPs. This study aims to examine the inclusion of cancer survivorship-related strategies and objectives in NCCPs of African countries.

Methods

Independent reviewers extracted strategies, objectives, and associated indicators related to survivorship care from 21 current or recently expired NCCPs in African countries. Building on a similar analysis of the US state cancer control plans, reviewers categorized these strategies according to an adapted version of the ten recommendations for comprehensive survivorship care detailed in the 2006 National Academy of Medicine report.

Results

A total of 202 survivorship-related strategies were identified, with all NCCPs including between 1 and 23 references to survivorship. Eighty-three (41%) strategies were linked to measurable indicators, and 128 (63%) of the survivorship-related strategies were explicitly focused on palliative care. The most frequent domains referenced were models of coordinated care (65 strategies), healthcare professional capacity (45), and developing and utilizing evidence-based guidelines (23). The least-referenced domains were survivorship care plans (4) and adequate and affordable health insurance (0).

Conclusions

The results of this study indicate that survivorship objectives and strategies should extend beyond palliative care to encompass all aspects of survivorship and should include indicators to measure progress.

Implications for cancer survivors

Stakeholders can use this baseline analysis to identify and address gaps in survivorship care at the national policy level.

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Data availability

The data that supported the findings of this study are available in the ICCP Portal at https://www.iccp-portal.org/map. Analyzed data are available on request from the corresponding author.

Abbreviations

APCA:

Africa Palliative Care Association

ECHO:

Extension for community healthcare outcomes

EML:

Essential medicine list

ICCP:

International Cancer Control Partnership

LMIC:

Low- and middle-income country

MASCC:

Multinational Association of Supportive Care in Cancer

NAM:

National Academy of Medicine

NCCP:

National cancer control plan

NCCS:

US National Coalition for Cancer Survivorship

NDCP:

Non-communicable disease plan

NCI:

US National Cancer Institute

US:

United States

WHO:

World Health Organization

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Acknowledgements

We thank the experts who reviewed this manuscript: Kalina Duncan (Center for Global Health, National Cancer Institute, National Institutes of Health, Rockville, MD, USA, Mandi L. Pratt-Chapman (George Washington University, Washington D.C., USA), and Timiya S. Nolan (The Ohio State University, Columbus, OH, USA. Thank you to Alicia A. Livinski (NIH Library, NIH, Bethesda, MD, USA) for the manuscript review, editing, and formatting.

Author information

Authors and Affiliations

  1. Center for Global Health, National Cancer Institute, National Institutes of Health, Rockville, MD, USA

    Elise M. Garton & Mishka Kohli Cira

  2. Kenya Hospices and Palliative Care Association, Nairobi, Kenya

    Zipporah Ali

  3. Johns Hopkins School of Nursing, Baltimore, MD, USA

    Laura Haskins

  4. Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA

    Paul B. Jacobsen & Michelle A. Mollica

  5. Department of Reproductive Endocrinology and Infertility, Mulago National Referral Hospital, Specialized Women and Neonatal Hospital, Kampala, Uganda

    Anthony Kayiira

  6. Lifesure Fertility and Gynecology Centre, Kampala, Uganda

    Anthony Kayiira

  7. University of Nigeria, Ituku-Ozalla Campus, Enugu, Nigeria

    Nwamaka Lasebikan

  8. Dept. of Anesthesia/Pain & Palliative Care Unit, College of Medicine, University of Nigeria, Ituku-Ozalla Campus, Enugu, Nigeria

    Tonia Onyeka

  9. Union for International Cancer Control, Geneva, Switzerland

    Yannick Romero & Zuzanna Tittenbrun

  10. George Washington University, Washington, D.C, USA

    Sylvia Shirima

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  1. Elise M. Garton
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Contributions

The work reported in the paper has been performed by the authors, unless clearly specified in the text. All authors aside from the first and last author are listed in alphabetical order.

AK, TO: data analysis, writing-original drafts, writing—review and editing

EMG: conceptualization, methodology, data analysis, project administration, writing—original drafts, writing-review and editing

LH: data extraction, writing—review and editing

MAM, PBJ: conceptualization, methodology, data extraction, writing-original drafts, writing—review and editing

MKC: conceptualization, methodology, data extraction, project administration, writing—original drafts, writing-review and editing

YR, ZT: conceptualization, methodology, data acquisition, data extraction, writing-original drafts, writing—review and editing

ZA, NL, SS: writing—review and editing

Corresponding author

Correspondence to Elise M. Garton.

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Competing interests

The authors declare no competing interests.

Ethics statement

Ethical approval was not required for this study.

Conflict of interest

The authors declare no competing interests.

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The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the National Cancer Institute, National Institutes of Health or US government or any of the authors’ organization.

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Garton, E.M., Ali, Z., Cira, M.K. et al. An analysis of survivorship care strategies in national cancer control plans in Africa. J Cancer Surviv 17, 634–645 (2023). https://doi.org/10.1007/s11764-022-01320-x

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