Analysis and recommendations to improve national cancer control plans and policies informed by a 20 country analysis

Introduction
As the global burden of cancer increases, international and national policymakers have made notable progress with the development of national cancer control plans (NCCPs). An increasing number of countries have published and updated their NCCPs; their design and implementation vary widely.

Methods
A literature scoping review was conducted to understand common challenges and progress in NCCPs across 20 representative countries based on a framework drafted to reflect the European Beating Cancer Plan and World Health Organisation’s guidance on NCCPs. In total, 103 sources were used for the analysis. These comprised of 42 official NCCPs, five accompanying documents, whilst the remainder (56) included other government official reports, academic, and grey literature. The research followed a standardised framework used to evaluate policies across five pillars: prevention, early detection, care, treatment, and quality-of-life.

Results
Across the 20 NCCPs, 65% assigned implementation of objectives to key stakeholders. A total of 25% of NCCPs did not include details on the allocated budget for implementation. Overall, there was variation in the definition of clear objectives and actionable targets across pillars. In the ‘Prevention’ pillar, most plans addressed reducing risk factors (80%), but less than half focus on increasing people’s awareness (40%). For ‘Early Detection’, 50% of NCCP included targets for cancer screening programmes, while 25% included targets for advanced diagnostics. NCCPs included well-defined objectives across ‘Care’ mechanisms, including centres of excellence (35%), multi-stakeholder engagement (50%), informed providers (40%), and cancer registries (55%). The pillar focused on ‘Treatment’ generally lacked actionable objectives, with low proportion of NCCPs having objectives related to early access (10%), access and reimbursement (15%), and none for regulatory approval or evidence requirements. Finally, plans demonstrated a relatively strong focus on ‘Quality-of-Life’ policy mechanisms, with clear goals and targets for palliative care (60%), support programmes (60%). ‘Research and Innovation’ and objectives related to these domains were highlighted across the cancer care continuum (65%). From a country perspective, NCCP Governance Scores (a measure of the inclusion of targeted, actionable objectives, allocated budgets, clearly assigned responsibilities, and monitoring reports) were highest in France, Ireland and Japan and lowest in Austria, Brazil, Norway, Saudi Arabia, Sweden and Turkiye, whereas NCCP Policy Indices (a measure of the inclusion of targeted, actionable objectives in each policy pillar) were higher in Belgium and Ireland and lower in Germany, Mexico, Switzerland The Netherlands and the US.

Conclusion
We propose the following recommendations to further enhance NCCPs: 1) Strengthen measurable and actionable targets, governance and evidence-based policy design and updates; 2) Ensure targeted allocation of funding and resources; 3) Promote equity through targeted action; 4) Future-proof investment goals in research; 5) Intensify efforts for integrated, accessible and interoperable cancer data; 6) Foster collaboration at sub-and above-country level to advance NCCP evolution; 7) Drive oncology research and innovation.